Single-payer plan is great idea; can California pull it off?


by Michael Hiltzick


California, which has shown the determination to go it alone in areas such as environmental protection, scientific research and workers’ rights when its values conflict with policies at the federal level, is moving forward with its most audacious effort yet. That’s a plan to create a universal single-payer healthcare system.


Called CalCare, the program would take over health coverage for more than 40 million residents from government policies such as Medicare and Medicaid and from private plans, whether sponsored by employers or purchased through the Affordable Care Act marketplace.


This would mean placing $400 billion in annual expenditures in the hands of a state governing board. Say goodbye to the dead hand of private health insurers, to navigating in-network and out-of-network charges, to deductibles and copays, to substandard dental, vision and hearing services. Every resident of the state, regardless of where they get their coverage now, would be eligible for the new system.


At least, that’s the promise. Whether the Legislature will be able to bring this idea to fruition is anyone’s guess.


Under its rules, the measure embodying the program, AB 1400, must be sent by Jan. 31 from the Assembly to the Senate, where it is likely to be masticated into the summer. The proposal, like its several predecessors introduced in recent years, is sponsored by the California Nurses Assn.


Not a few Assembly members have expressed skepticism, but it’s a bit early to pull the plug. I agree with my colleague George Skelton that this is “a debate worth having.”


California has tried to enact a universal single-payer program many times in the past. Each time, it foundered over concerns about its cost and opposition from politically potent interests such as the commercial insurance industry and the California Medical Assn.


In 2018, for instance, a proposal almost identical to AB 1400 was torpedoed by Assembly Speaker Anthony Rendon (D-Lakewood). The uproar his action generated, however, forced him to establish a legislative committee to examine how to achieve universal health coverage in the state.


The 2018 proposal, like the new version, would have taken over responsibility for almost all medical spending in the state while relieving employers, their workers and buyers in the individual market of premiums and out-of-pocket expenses.

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