Piecemeal bills will not fix California's health care. Single payer is the only solution

Members of the California Nurses Association and supporters rally at the state Capitol in June 2017 to call for a single-payer health plan.
Members of the California Nurses Association and supporters rally at the state Capitol in June 2017 to call for a single-payer health plan. AP

Scrambling to avoid a systemic fix for our unraveling health care system, leaders of the California Assembly, joined by a few other groups, are floating piecemeal proposals that will still leave millions of Californians grappling for health security.

Last June, Assembly Speaker Anthony Rendon unilaterally blocked public hearings, amendments and legislative votes on Senate Bill 562, a Medicare-for-all proposal that had passed the state Senate and that would guarantee health care for all Californians without ever-rising premiums, deductibles and other costs.

DeborahBurger 2017.jpg
Deborah Burger

Now desperate for the appearance of action in an election year, Rendon is telling legislators to let a 1,000 ideas bloom. But in a telling admission, lobbyists for the California Medical Association characterized these bills as giving cover to Democrats not to support single payer as proposed by the California Nurses Association.

With some notable exceptions – expansion of Medi-Cal to cover undocumented people, which is not only humane but essential for public health, since communicable disease does not discriminate – several of these ideas will provide little relief.


One proposal is a California mandate for individuals to have coverage to replace the federal requirement repealed by Congress. But the Affordable Care Act’s mandate was essentially intended to bribe insurance companies to stop denying coverage to people with chronic conditions or prior health problems. And the mandate is a de-facto tax, forcing people without coverage to buy insurance without effective cost controls, and proved to be wildly unpopular, undermining support for the ACA.

Moreover, with decades of practice, insurance companies still found ways to game the system, such as narrow networks that exclude specialists, hospitals and clinics, or restrictive benefit packages that screen out patients with cancer or other serious illnesses.

Another idea is to create a California “public option” as an alternative to private insurers. In theory, a public plan would cost less by not having to siphon off revenues for profits, marketing or lucrative executive pay.

The real-life experience would be far different. Medicare works by covering everyone 65 and older in one large risk pool to balance out sicker patients with healthier people. But the public plan would not have that protection. It would end up with the sicker patients dumped by the private insurers and much higher operating costs requiring continual cash infusions from the state to survive.

A third proposal: state subsidies for individuals to buy insurance, replacing cuts in federal subsidies. But with no real controls on how much insurance companies jack up premiums and deductibles, these state payments will become an endless spiral of escalating taxpayer funding of insurance profits.

Covered California recently projected that premiums will leap by 35 percent by 2021. How many Californians are likely to get a 35 percent pay increase by then? Even Assembly-hired researchers admitted that more than 20 percent of Californians with insurance struggle with medical bills, meaning they use up their savings or go without seeing a doctor when sick.

There’s still time this year for the Legislature to act. Why go for an inadequate, fragmented package of bills that will prolong the suffering for too many and may be just as hard to pass, when the real solution, SB 562, remains at hand?

Deborah Burger, a registered nurse in Sonoma County, is co-president of the California Nurses Association. She can be contacted at