Single Payer in the Golden State

The fight for Medicare for all goes to California.

Joel Bleifuss April 19, 2017

Single payer will be an issue in the 2018 midterm elections. (Justin Sullivan/Getty Images)

The Afford­able Care Act (ACA) and mil­lions of its ben­e­fi­cia­ries are safe, for now, from the GOP’s con­gres­sion­al death pan­els. The health­care fight is just get­ting start­ed. In March, Bernie Sanders said he would intro­duce a Medicare-for-all sin­gle-pay­er” bill in the Senate.

The next big healthcare showdown, however, is shaping up in California. On one side, the Democratic legislature; on the other, it seems, is Jerry Brown, the Democratic governor.

The next big health­care show­down, how­ev­er, is shap­ing up in Cal­i­for­nia. On one side, the Demo­c­ra­t­ic leg­is­la­ture; on the oth­er, it seems, is Jer­ry Brown, the Demo­c­ra­t­ic governor.

On Feb­ru­ary 17, Demo­c­ra­t­ic state Sens. Ricar­do Lara and Toni Atkins intro­duced the Healthy Cal­i­for­nia Act, leg­is­la­tion that would estab­lish a sin­gle-pay­er plan for all 38 mil­lion res­i­dents, includ­ing undoc­u­ment­ed cit­i­zens. Every­one has a right to health­care,” said Lara, when announc­ing the leg­is­la­tion. We’ll nev­er get to 100 per­cent health­care in Cal­i­for­nia unless we lead.”

California’s leg­is­la­ture passed sim­i­lar bills in 2006 and 2008, both of which were vetoed by Gov. Arnold Schwarzeneg­ger ®. With a Demo­c­rat back in the governor’s office, one might imag­ine the mea­sure to be a done deal. But Brown, who sup­port­ed sin­gle pay­er in 1992, is these days not so enthu­si­as­tic. Like many a Demo­c­ra­t­ic offi­cial fac­ing a base with ris­ing expec­ta­tions and ambi­tious demands, Brown has been hand­wring­ing about costs, effec­tive­ly doing the Repub­li­cans’ work for them.

The upfront costs are a con­cern, but not an insur­mount­able bar­ri­er. The ACA, thank­ful­ly intact, pro­vides Cal­i­for­nia a finan­cial launch pad. A sig­nif­i­cant part of the start-up costs would be fund­ed through fed­er­al waivers for the ACA, as well as Med­iCal, the Children’s Health Insur­ance Pro­gram and Medicare.

On March 30, Lara released details about the sin­gle-pay­er plan. The state would nego­ti­ate prices for ser­vices and pre­scrip­tions with health­care providers and phar­ma­ceu­ti­cal com­pa­nies. All Cal­i­for­ni­ans would be required to par­tic­i­pate in the program.

Oth­er states have also tried — and failed — to pass sin­gle pay­er. Col­orado vot­ers reject­ed a sin­gle-pay­er bal­lot mea­sure last Novem­ber, thanks to pub­lic fears about costs — fears stoked by the insur­ance indus­try, the state GOP, busi­ness groups and Gov. John Hick­en­loop­er (D). In 2014 in Ver­mont, the mil­que­toast Gov. Peter Shum­lin (D) aban­doned a sin­gle­pay­er plan passed in the leg­is­la­ture because, as he put it, the poten­tial eco­nom­ic dis­rup­tion and risks would be too great.”

Cal­i­for­nia will find more inspi­ra­tion up in America’s attic. In 1947 in Saskatchewan, Pre­mier Tom­my Dou­glas of the Co-oper­a­tive Com­mon­wealth Fed­er­a­tion (CCF), a demo­c­ra­t­ic social­ist par­ty, estab­lished the embryo of Canada’s sin­gle-pay­er health­care sys­tem. The idea spread from province to province, and it was insti­tut­ed nation­wide in 1984.

Cal­i­for­nia may not have Dou­glas’ CCF, but it has RoseAnn DeMoro’s Cal­i­for­nia Nurs­es Asso­ci­a­tion, with its 100,000 mem­bers, and it has Our Rev­o­lu­tion, the activist off­shoot of the Sanders cam­paign, which in Cal­i­for­nia is 400,000 strong. Both orga­ni­za­tions plan to mobi­lize in sup­port of the bill.

Sanders’ pro­pos­al is not like­ly to pass in the cur­rent Con­gress. But it may pro­vide the boost of polit­i­cal will need­ed for Cal­i­for­nia pro­gres­sives to change Jer­ry Brown’s mind. And it puts his con­gres­sion­al col­leagues on notice: Sin­gle pay­er will be an issue in the 2018 midterm elections.

Joel Blei­fuss, a for­mer direc­tor of the Peace Stud­ies Pro­gram at the Uni­ver­si­ty of Mis­souri-Colum­bia, is the edi­tor & pub­lish­er of In These Times, where he has worked since Octo­ber 1986.

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