Single payer is still best health care fix for California

Supporters of a single-payer health care bill protest in the state Capitol this year.
Supporters of a single-payer health care bill protest in the state Capitol this year. Sacramento Bee file

With growing alarm in Sacramento over attacks on health care in Washington – threats to the Children’s Health Insurance Program and the Medicare cuts sure to come under the GOP tax plan – there’s no shortage of irony in the frantic search by Assembly Speaker Anthony Rendon to find alternatives to a solution readily at hand, the guaranteed health care bill.


Rendon set up the powerless Assembly Select Committee to provide cover for his heavy-handed decision in June to block public hearings and amendments on Senate Bill 562. In its latest meeting, the committee tried to outline incremental steps to get to universal coverage.

But after hearing policy wonks float ideas including rate regulation and more taxpayer subsidies to private insurance companies, Larry Levitt of the Kaiser Family Foundation provided a conclusion that didn’t exactly fit into Rendon’s plan – that the most far-reaching step would be to create a single-payer system. It’s the simplest approach, controls costs controls and can be done all at once, Levitt said.

Incremental steps would provide little help for the 15 million Californians who still lack coverage, or who can’t afford to use the insurance they have. Indeed, only SB 562 would guarantee coverage for all Californians, without the crippling deductibles and other out-of-pocket costs that force far too many to buy junk insurance, skip needed medical care or even face bankruptcy due to inflated medical bills.

“Cost containment” was the buzz phrase at the hearing, but let patients beware. Private insurers cut costs by restricting networks of doctors and hospitals, limiting choices of prescription drugs, denying claims and by requiring pre-treatment authorizations and high deductibles to discourage patients from getting the care they need.

By contrast, SB 562 would actually cut costs by eliminating the 18 percent siphoned off for profits and paperwork. Further, it would lower costs by adopting Medicare rates, using the power of the state to negotiate discount prices for drugs and by setting total budgets for hospitals and other providers.

Rate regulation is the other talking point. But it fails to grasp the central problem of our health care system – the private insurance middlemen who add no value for patients and whose focus is profits, not delivering care. Two of the state’s largest insurers, Anthem Blue Cross and Blue Shield, were fined in recent months for failing to address member grievances, but a shark is not about to stop eating flesh because it gets slapped.

Under a rate regulation system, insurance companies would still have the same business model. Rate regulation may be able to reduce some abuses, but only a single-payer system can eliminate them.

SB 562 has already passed the Senate and is ready to move forward early next year, if only Rendon will free it from house arrest in the Assembly and let it go through hearings and amendments.

Malinda Markowitz is a registered nurse in San Jose and co-president of the California Nurses Association. She can be contacted at