Single-Payer Health Care Bill Introduced In California Senate

A woman has her blood drawn at a free clinic for the uninsured held April 27, 2016 at the Los Angeles Convention Center.

A woman has her blood drawn at a free clinic for the uninsured held April 27, 2016 at the Los Angeles Convention Center. (FREDERIC J. BROWN/AFP/Getty Images)

Legislation introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.

The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.

A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.

Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.

Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.

“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”

Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.

“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.

He recently withdrew a request to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.

Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)

Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)

According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.

No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.

In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.

It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)

“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”

The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”

The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento next week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.

“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”

Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.

Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.

“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”

He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.

One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.

Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.

“I think we’ve reached a tipping point now that we haven’t had before,” he said.

  • Hillary Clintub

    Anywhere other than California, they call single payer a “monopoly”. I thought we’d decided long ago that monopolies weren’t all that good for consumers. Monopolies mean the elimination of competition. So does “socialism”.

    • potatoz

      Is there a monopoly on law enforcement? Is there a monopoly on K-12 education? Is there a monopoly on sewer service?

      You can go ahead and get your own (private security, charter school, a septic system), the government just ensures everyone has access to a public option. Same here.

      • Charles Driver

        Thank you for shutting that fool down.

    • City Resident

      Numerous nations deliver high quality healthcare far more equitably and at lower cost than our country does, and they are able to do so with single payer systems. Health insurance companies tend to be for-profit bureaucracies which don’t provide (but instead manage the billing of) health care. We can do better.

      • Curious

        Numerous nations have tax rates that are double ours and everyone pays – not just the suckers.

        • City Resident

          To clarify, numerous nations deliver high quality healthcare far more equitably and at lower cost than our country does and have tax rates similar to ours, for the vast majority of their citizens. It’s about priorities. What do we value? How many do we incarcerate? How much do we care about one another, rich or poor?

          • Curious

            “numerous nations deliver high quality healthcare far more equitably and at lower cost than our country does and have tax rates similar to ours, for the vast majority of their citizens”
            Please identify these numerous countries.

          • City Resident

            Some of the countries are: Australia, Austria, Belgium, Canada, Czech Rep., Finland, France, Germany, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Slovenia, South Korea, Spain, Switzerland, and the United Kingdom. These countries have health insurance coverage rates of between 97.2% and 100%. https://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf

            In the U.S., over 9% of the population lacks health insurance.

            You may wish to check out OECD Health Statistics 2013 at: http://dx.doi.org/10.1787/health-data-en. 1 2 http://dx.doi.org/10.1787/888932918491
            or (for tax rates): http://stats.oecd.org/index.aspx?DataSetCode=TABLE_I7

          • Curious

            You see that the tax rates in these countries are all higher, right?
            You know that many of these countries have failing health care systems that have far worse results than the US, right? You know that in many of these countries, people with “coverage” die waiting to see a doctor? You know that people in many of these countries come to the US for treatment? You know that these countries do not have open borders with millions of ill people flooding in for free treatment, right?

          • City Resident

            The tax rates at the link show rates that are surprisingly similar to ours. Please provide evidence to support your assertions. Having lived and worked in one of the countries cited (Austria), I know that your statements certainly don’t apply in that case. Many myths have been promoted about the supposed inferiority of other countries’ healthcare systems. The links I included (to OECD statistics) seem to refute these myths.

          • Curious

            False.

          • City Resident

            What is false? The facts or the fiction?

          • Everett Engbers

            There is no convincing people who are so invested in their own ideology that they can’t even bother to back their rhetoric up with facts. The bottom line is, these people believe that everything in life has to be subjected to the for-profit benefit of the so-called “free market”. Yes, even life and death has to be the business of Capital. They worry about an increase in taxes, while ignoring the obscene amount of the Federal budget devoted to the military, a military already capable of destroying the world several times over.

          • Tony Perera

            Show us the stats from a legitimate news source. Hopefully one from those countries.

        • Tony Perera

          They also don’t have the population numbers that can contribute the tax volume needed.

    • Tony Perera

      That’s a wrong assumption. Why aren’t Canadians or Brits fleeing their countries if their model is worse? If they can, we can do better should be the mantra not it”s hard so why try. Darwin’s theory didn’t work for the later.

      • Hillary Clintub

        Britain’s National Health Service is rapidly going broke.

  • Curious

    More freebies for the lazy.

    • Tony Perera

      It doesn’t help your argument to call names, Trumptard.

  • Advisor_37years

    What fools.This is a way to tell all California businesses to go away. Vermont found that payroll taxes would have to be 20% or more (on top of our 13.3% CA income tax, 39% federal tax, and 15.3% FICA/Medicare.) And what doctor would be willing to accept the low payments that a single payer system would require? If this passes, I will invite my very sick sister to come live with me and suck off the California taxpayers. She’s a least a US citizen and should have that right over the illegal immigrants. California already has $400 billion in unfunded pension and health care liabilities: single payer would double that.

    • City Resident

      Many doctors, hospitals, and clinics readily welcome patients with Medicare, which is also a single payer system. Numerous nations have such universal single payer systems in place and they deliver healthcare at lower overall cost than what we pay in our country for healthcare.

      • Advisor_37years

        Thanks for your civil response. However I totally disagree with you. Single payer works in other countries because of rationing and a ruthless depression of medical costs. Doctors in Germany get half of what physicians make in the US. Unless California forces physicians and medical providers to accept single payer (government) patients, there will be many if not most who will opt out of that system. I assume you are a resident of a city (from your disquis name) but I live in an area where it is very hard to find a doctor who takes either Medicare or Medi-cal. Maybe 20%. Hardly I think California as a whole is more like my area than your city. For an excellent article on why single payer is not viable in the US without major changes, please read Megan McArdle’s article: https://www.bloomberg.com/view/articles/2014-04-30/single-payer-would-make-health-care-worse.

        • City Resident

          I appreciate your civil response, as well. As to doctors in Germany earning well less than their U.S. counterparts, I believe this may be true of many professions (and therefore less attributable to their health insurance system but more due to other economic factors). I am well familiar with Austria (a country fairly similar to Germany) and, in Austria, I know many professionals (doctors, engineers, attorneys) earn well less than what many professionals do in the U.S. In general, their middle class is far broader and income inequality is less prevalent. Although this segment of the work force earns less, many of them appreciate being able to live in a society with more equality and less social discord and injustice. All employees have excellent, legally mandated benefits (health insurance, 5+ weeks annual vacation, etc.). Although not measured by annual income, there is considerable societal and individual benefit derived from their single payer system and other public programs.

          As to rationing, please explain what you mean. Clearly, our system rations care. Those without health insurance coverage receive no care, except for at the ER – which drives up costs for all. Other rationing exists in the U.S. as well, with insurance denials. I am also curious to better understand what you describe as “ruthless depression of medical costs.”

          It is my understanding that the Affordable Care Act helped address some of the drawbacks/barriers of accessing health care in rural communities. Further improvements appear to be needed. Relevant to this discussion, it is worth pointing out that Medicare’s administrative and overhead costs are much lower than those of private insurance companies (http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/).

          These are complex issues that I can not pretend to fully understand. I do know, from the point of view of a registered nurse and a health care consumer (and as someone who has worked and lived in both the U.S. and Austria), that health care is accessible to all in the single payer system in Austria – whether you are a dishwasher or a CEO, you receive first class care.

          • Advisor_37years

            I agree that average wages are less than US and that their taxes pay for their social welfare programs. I don’t want that kind of society for the US. Too long to go into the reasoning.

            Rationing in the US effects about 15% of the population, according to Wikipedia. However in other countries, UK, Canada slow down care or deny coverage. This is rationing. Again, I suggest another article by Bloomberg author Megan McArtle https://origin-www.bloombergview.com/articles/2016-01-22/health-care-s-continental-divide. She debates European health care vs US health care and the pros and cons of single payer care.

            I follow the health care debate and am also very concerned about single payer. The VA system is true single payer and many, many people are very unhappy with that system. I see no way to dramatically lower costs of service without lower the wages of health care professionals. How do you feel about earning half of what your currently earn?

          • City Resident

            Thank you for your response. I read the articles you suggested and especially appreciated the comparison and discussion of the U.S. and German healthcare insurance systems. From that article, the Bloomberg View journalist (who says she has “long opposed a comprehensive national health-care system for America”) said we have “a messy, fractious democracy that offers interest groups almost unlimited veto points against legislation they don’t like.” Clearly, this is one of the barriers to the reform of many ongoing problems in our country.

            As to healthcare professionals earning less in the interest of helping all of us attain a more equitable, accessible, and affordable healthcare system, I am definitely in agreement with this. As it now stands, the inequality and injustice amongst us could be reduced if the haves had a little less and the have nots had a little more. Greed and anxiety is a part of life for many Americans. It need not stay this way. Clearly many would object to a 50% salary reduction (and a more modest reduction would be more acceptable and appropriate). Many would prefer to first (or simultaneously) see extremely well compensated healthcare CEOs and other highly paid executives who provide little or no patient care (and have little or no risk of workplace injury) receive substantial pay cuts. For the same reason, it seems reasonable to increase efficiency and decrease the role of the “middleman” (health insurance companies). As I noted, Medicare’s administrative and overhead costs are lower – something like 2% vs. as high as perhaps 18% amongst some private insurance companies.

            I am curious as to what, if any, remedy you suggest for health care in the U.S.? By the way, you may appreciate the following, slightly dated, article: http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

          • Advisor_37years

            Thank you for asking. I think catastrophic care should be paid for by a national payroll tax on both the employer and employee, but it should start gradually at 5% (each) and increase annually until it reaches 7.5%, when it would also prepay for long term care. The maximum contribution would be $5000. No one should be financially devastated by cancer, an accident or heart attack. I also think we should have individual HSA that pay for ordinary and predictable expenses, including well visits, blood tests, etc. As an employer, I would be happy to contribute to a HSA. I did this for years until the ACA made defined contribution healthcare unlawful. Finally, I think that when medical expenses become more than 10% of a person’s or family’s income, I think that the state government should step in and help. This would be funded by block grants per capita (legal residents and citizens only) by the federal government. My philosophy is that control should rest with the consumer as much as possible and that we should train people to manage their own healthcare.

          • City Resident

            Interesting ideas – many of which sound appealing and positive. Thanks for sharing them. May I ask why you’d cap the maximum contribution to a catastrophic care plan at $5,000?

          • Tony Perera

            Private insurance companies won’t go away just because single payer exists. You’ve heard of dog spas? If there’s someone willing to pay for private insurance someone will provide it. And you need not worry. Also this is happening only in CA nobody is forcing it on you.

        • Tony Perera

          You’re defending a profit motivated business model. Do even know about the Hippocratic Oath that doctors must take? It doesn’t change because you practice in the states. No such thing as alternative hippocratic oath.

    • Dawn Sunburst

      I don’t think your sister will be able to come and immediately enroll, they will probably limit the services to California residents such as yourself.

      • Advisor_37years

        Actually I think she could. Tax Franchise Board says that anyone who intends to make their home permanently in California will be considered a resident. DMV will give a DL right away; voter registration right away. One year residency required for in-state tuition unless you are supported by a California taxpayer.

  • Joe Neri

    Vermont should have joined forces with the rest of the New England states to share costs for a regional single payer system. Similarly, California could assemble a coalition of western states to finance a system, probably only providing basic coverage and allow individuals and companies to purchase further coverage in the marketplace.

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