For those on the left side of the political scale, no issue is more important – or more elusive – than whether medical care can be provided directly through a government system.
Dubbed a single-payer system, it would eliminate insurers and other aspects of the private business of medical care and provide everyone with the same services, regardless of their income or other characteristics.
Not surprisingly, those who want it were delighted when, in 2018, the leading Democratic candidate for governor of California all but promised to make it happen.
“I’m tired of politicians saying they support single-payer, but it’s too early, too expensive or someone else’s problem,” Gavin Newsom said.
Newsom’s pledge has earned him the support of single-payer advocates such as the California Nurses Association. He decorated a bus with Newsom’s face and the words Nurses Trust Newsom. He shares our values and our fights for our patients and has visited the state.
Once elected, however, Newsom backed away from his promise, saying his goal was universal health coverage, not necessarily single-payer.
I think the ideal system is a single-payer system, Newsom said in 2022 when pressed by reporters about his commitment. I’ve been consistent with this for over a decade. The difference here is that when you are in a position of responsibility, you must apply, you must manifest the ideal. This is a difficult work. It’s one thing to say, it’s another to do. And with respect, there are many different paths to achieving this goal.
Gradually, he and the Legislature expanded Medi-Cal to groups lacking coverage, such as undocumented immigrants. These actions, along with Obamacare mandates and subsidies, ultimately resulted in 94.8 percent of Californians being covered, according to a recent UCLA survey.
The question arose again this year with two measures in Parliament: one creating a framework for a universal system, and the other an increase in taxes on businesses to finance it.
The tax proposal would raise about $150 billion a year to offset the loss of employer-provided coverage, or about a third of the estimated cost of a single-payer system for nearly 40 million Californians. The rest would, in theory, come from pooling funds already spent by federal, state and local governments.
The tax measure went nowhere, but the other bill, Senate Bill 770, was signed by Newsom last week.
SB 770 directs state officials to negotiate with federal authorities a waiver under which money currently spent on health care comes from Washington — about 50 percent of the state’s total public and private medical spending – would be returned to the State.
It would fund a comprehensive package of medical, behavioral health, pharmacy, dental and vision benefits, which includes primary care, preventive and wellness services, as required by the legislation.
It does not specify a single-payer system, and some advocates, including the Nurses Association, have opposed it. He describes Newton’s approval of SB 770 as a complete betrayal of nurses’ fight for single-payer health care policy, a fight to achieve health justice for our patients and communities.
However, other advocates see SB 770 as advancing the concept because federal funding is essential.
At most, SB 770 is a small step. Getting the federal government to pay more than $200 billion will be difficult because it would supplant Medicare, which covers the elderly, and the systems that now cover federal employees, as well as government and staff retirees. military.
A single-payer system would also force Californians who currently receive care through employers, unions or public agencies to forgo their benefits and join a universal system.
Would they be willing to entrust their medical needs to a state government with a dismal record in handling large programs – such as the Department of Employment Development and the high-speed rail project?
Dan Walters is a CalMatters columnist.
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