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Hart writes: "While Republicans in Washington are seeking to resurrect their plan to dismantle Obamacare and replace it with a market-based approach, a pair of Democratic California lawmakers are plotting to go in the opposite direction."

California governor Jerry Brown. (photo: LA Times)
California governor Jerry Brown. (photo: LA Times)


Could California Become the Next Canada for Health Care?

By Angela Hart, The Sacramento Bee

23 April 17

 

tate Sen. Ricardo Lara didn’t move to Canada following Donald Trump’s win last November, but he visited last week.

While touring a major research hospital in Toronto, he said he realized that American views on providing health care are becoming more Canadian.

“One fundamental difference between the United States and Canada is that they see health care as a human right … there’s a sense of pride that everyone has access to health care,” he said.

Since Trump’s election, he said, “attitudes are changing – particularly in California.”

While Republicans in Washington are seeking to resurrect their plan to dismantle Obamacare and replace it with a market-based approach, a pair of Democratic California lawmakers are plotting to go in the opposite direction.

Lara, of Bell Gardens, and Sen. Toni Atkins of San Diego, with backing from National Nurses United and the Bernie Sanders wing of the Democratic Party, are working to create a universal, government-run health care system. They believe California can be a proving ground for an approach that could be replicated across the nation.

“In Canada, this system came from the local level and went province to province. We think this could be a model for the United States,” Lara said. “California can set the standard for how we revolutionize health care delivery for all the residents of this country.”

Under a “single-payer” system like Canada’s, the government would pay health care bills instead of multiple insurance companies. Private hospitals and doctors would provide the care. Premiums, copays and deductibles would disappear. The money would come from state and federal governments and new taxes, likely on earnings, and paid by employers and employees.

It’s the same way Medicare functions, essentially. Proponents say it’s a practical way to rein in rising health care costs, expand access and improve quality. Critics argue that such systems lead to unacceptable levels of taxation, rationed care that can make people sicker and long wait lists for primary and specialty care appointments.

Past efforts to create such a system in California went nowhere. Yet Lara and Atkins have some factors working in their favor this time.

California is fertile political territory for a model that has long represented the ideology of the far left. Democrats controls both houses in the state Legislature, and they’re in power at a time when the state is growing more blue. Voters overwhelmingly backed Hillary Clinton over Trump last November and legalized recreational marijuana. They’ve also shown a willingness to tax themselves to pay for services. And Obamacare has been more successful here than in many other states.

The next generation of political leaders is sympathetic to their cause. Lt. Gov. Gavin Newsom, the frontrunner in the growing field of competitors vying to succeed Gov. Jerry Brown, supports single-payer. He is seeking to make health care a key issue in his campaign, calling it “the issue of our time.”

Newsom was endorsed early by the powerful California Nurses Association, which has long pushed for single-payer health care. RoseAnn DeMoro, executive director of the nurses union, said Newsom’s position, along with his track record of taking public stances on liberal causes before they are widely popular – on gay marriage and legal marijuana, for example – heavily influenced their decision.

“Gavin’s been consistent throughout his career – he’s unafraid,” DeMoro said. “He’s always been with the nurses on single-payer Medicare-for-all. It’s his passion … and he’ll fight for it.”

Still, several efforts over the past 25 years to adopt a single-payer system have run into fatal flaws in the Legislature and at the ballot box. The biggest challenge has been its steep cost.

“Single-payer has been the holy grail for some progressives but has fatal problems with voters, who are generally satisfied with their health care and want to see Obamacare work,” said Ned Wigglesworth, a partner at Spectrum Campaigns who ran a 2014 campaign against a measure that sought to allow the state to regulate insurance rates.

“The Trump election and floundering efforts to repeal and replace Obamacare may have breathed some life into this issue for now, but that’s not enough to sustain a single-payer proposal once cost and other concerns are brought into focus,” he said.

Opponents helped defeat a previous effort in the Legislature to adopt single-payer a decade ago, in part by branding it “socialized medicine.”

Sheila Kuehl, a former state senator now on the Los Angeles County Board of Supervisors, for years had tried to get a single-payer bill to the governor’s desk. She succeeded in 2006, when Senate Bill 840 at the time became the first such legislation to pass the full Legislature. It came after several previous attempts, including a failed ballot initiative in 1994.

Former Gov. Arnold Schwarzenegger vetoed Kuehl’s bill, citing its steep cost. The bill sought to overhaul health care financing by realigning state and federal funding into a one-payment system, combined with new payroll taxes. The idea was to control costs by regulating premiums, curbing administrative costs and eliminating high-paid salaries for top executives.

The Legislative Analyst’s Office found it would still face severe funding shortfalls – more than $29 billion in the first year, growing to $46 billion after five years of implementation.

Proposition 186, the 1994 ballot initiative, failed miserably, with more than 73 percent of voters opposed at the time.

“I think this bill would result in doctors saying they don’t want to take the government reimbursement rates, and ultimately leaving the state,” said Sally Pipes, president and CEO of the conservative Pacific Research Institute. “Single-payer would be very, very expensive, and those costs would be borne by California taxpayers, who are already paying enough.”

While Republicans are its most forceful opponents, some Democrats in the Legislature are also skeptical.

“I don’t know if there’s the stomach to pass this if the costs are so high,” said Assemblyman Jim Cooper, a moderate Democrat from Elk Grove. “If we keep raising taxes on people, at some point people aren’t going to be able to afford them. We have to be very careful, because at some point I think the public will push back.”

Support for the bill could be politically risky for some Democrats in swing districts, especially on the heels of Brown’s $52 billion transportation plan that raises gas taxes.

“Most of the Democrats in competitive districts won their seats last year by convincing voters they were more moderate,” said Dan Schnur, a longtime political analyst and now professor at the University of Southern California’s Annenberg School of Communications. “They’re likely to have reservations about raising taxes … taking two hits for the team could give their opponents an opportunity to attack them as too liberal.”

Brown, whose job performance has hit record highs, could be a wild card.

He argued passionately for single-payer during his 1992 presidential run. At a 1992 health care forum in Miami, he proposed a model that mirrors the current proposal.

“I believe the only health care system that makes any sense is a single-payer system, similar to what has been adopted in Canada, where everyone would be in one universal system but maintaining the right of private physicians and private hospitals and private choice,” Brown said at the time. “Health care is not a commodity, it’s a right.”

Yet he cast doubt on the current proposal last month, asking, “Where do you get the extra money?”

That comment raised concern from DeMoro, also a fierce supporter of Vermont Sen. Bernie Sanders, who is proposing a national single-payer system.

“I have no idea what Jerry was doing – he shouldn’t have done that,” DeMoro said. “He said show me how to pay for it. Well, we look forward to showing him how we’re going to do it. There has never been a more incredible moment in history that has exposed deep fear and underlying concerns of people not being able to get the health care they need.”

Lara and Atkins said they are working to address concerns that have killed past single-payer proposals. A wide-ranging financial analysis is underway.

Atkins has floated an idea to offset steep costs by dissolving workers’ compensation insurance. Under that change, people with work-related illness or injuries could use their regular doctors, eliminating those costs for employers.

“In the past I’ve said it wasn’t possible,” Atkins said. “What makes us different now is the experience with the Affordable Care Act. I’m hearing and seeing an appetite to do more.”


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+18 # Wise woman 2017-04-23 17:06
I've said it before and I'll say it again. Single payer has NEVER bankrupted a country - read Scandinavia, France, Germany and Canada, etc. These countries have happier, healthier and smarter people than we have here. What they don't have is millionaire incompetent docs. When one isn't stressed to the max worrying about what will happen if they become really sick, the outcome is happier and healthier. Stress kills!
 
 
+15 # Working Class 2017-04-24 07:58
Wise Woman is absolutely correct. And the argument of "where do we get the money" is a red herring. We are spend "the money" now. It only matters politically if you call it premiums or taxes, it still money out of the pockets of employers and employees. Cost of treating the uninsured at the e-emergency room or hospital is passed on to the rest of those with insurance in the form of higher cost for treatment which raises insurance cost in the long run. That cost driver goes away with Single Payer, as does the need for a Worker's Comp system. There are no examples of a Market Based Health Care Insurance System working - not one - anywhere in the world. Ours has been failing for decades, with higher and higher premiums and some of the worse health outcomes in the industrialized world. The few of the Affordable Care Act is it did not allow a Medicare for All option, it left the profit sucking private insurance companies in place. On average the take 24% off the top of premiums for administration and profit. Where do we get "the money" for Single Payer"? We spend more now than any other industrialized nation by far - use that money.
 
 
+3 # Buddha 2017-04-25 12:09
We will never get single-payer when we also use the Right's narratives, twice this article quoted "its steep cost". It only looks more costly if one mistakenly assumes that single-payer ADDS-ON to current spending. Instead, it replaces for-profit HMO's and thus is CHEAPER, something proven in every single-payer model across the globe. It is those who shill for the HMO's who will lie about single-payer's "cost", we shouldn't reinforce Right Wing memes.
 
 
+1 # Working Class 2017-04-25 14:37
Buddha - you are 100% correct. Keep up the fight.
 
 
+3 # reiverpacific 2017-04-25 14:45
"I've said it before and I'll say it again", -also.
I grew up in the UK and it saved my life twice, whereas I've been bankrupted here -with decent self-employed insurance (Insurance shouldn't even come into the equation) for being dragged into the ER with a bleeding ulcer.
I've also gone back to Scotland for non-emergency but necessary surgery and the round-trip airfare from the west coast was LESS than the one-way ride in the ambulance on the aforesaid instance. Better results too.
Universal care's administrative costs are on average between 7% & 10% of the total, whereas here, it's between 30% & 40%, a chunk of which is gobbled up by big insurance company's many employees sitting at a desk scrutinizing claims, seeking any tiny basis for denial (does anybody here really READ their insurance paperwork?).
Hell in Australia and Singapore, when my late ex-wife had to have and annual CT scan as an aftermath for her pituitary surgery here, they didn't even ask for insurance, nor send us a bill, in spite of the proffered 100% overseas insurance.
I could hammer away ad nauseum but y'all get the gist, what?!
 

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