Single Payer Health Care Is Back On The Table In California

It’s been a year and one month since California Gov. Gavin Newsom wrote to the White House about creating a single-payer health care system for the state. It was his first day in office, after having called for a health care overhaul on the campaign trail. 

Now, he’s bringing back the push to create one government health provider for all Californians. 

Last month, he convened his Healthy California for All Commission for the first time. The goal is to provide “coverage and access through a unified financing system, including, but not limited to a single payer financing system,” according to a press release about the launch. 

Part of the commission’s job will be taking stock of California’s current health care system and figuring out what a transition to single-payer might look like, including who would pay for it. The group is largely made up of academics and philanthropists. 

It also includes a representative from the California Nurses Association, which was a major backer of a 2017 single-payer bill that spurred weeks of debate at the Capitol. Assembly Speaker Anthony Rendon shelved Senate Bill 562 in June of that year, calling it “woefully incomplete” due to a lack of information about where funding would come from.

But enthusiasm for the idea hasn’t faded. 

Carmen Comsti, a regulatory policy specialist with the association and a member of the new commission, wrote in a statement that California should provide health care to all residents regardless of their ability to pay.

“The most effective and efficient way that our state could do so is through a unified financing system, a single-payer healthcare system,” she said. “The Healthy California for All Commission would take California closer to this principle.”

Moving to single-payer could take years, given the lack of support from the federal government. 

In the meantime, the governor has taken steps toward universal health care, the idea of covering all Californians through several different programs.  

During his first year in office, he expanded Medi-Cal coverage to undocumented young adults up to age 26, and created new subsidies for low- and-middle-income Californians buying on the state health insurance exchange. 

Anthony Wright, director of consumer advocacy organization Health Access and a commission member, said all the steps Newsom has taken, including forming the commission, have been “building blocks” to achieving a single-payer system.

“Some of the opposition [to single-payer]  is based on misinformation, so having details would help rebut some of that,” he said. “Other things would require other policy solutions, or to say, ‘What can we do to make this system simpler so we’re ready then to take the next leap?’”

The commission will prepare an initial report for the governor and Legislature by July 2020, and a final report by February 2021.

But some conservative health policy analysts are taking issue with the new group. 

Sally Pipes, president of the Pacific Research Institute and author of a book on the flaws of single-payer health care, argued in a Fox News opinion piece that California’s proposals would only lead to high taxes and longer patient wait times. 

“The state can scarcely afford the expansions of public health coverage the Newsom administration has already green-lit,” she wrote. “[The commission] shouldn't need a year, much less six months, to determine that a government takeover of California's health care system would be ruinous for the state's finances and patients.”

The state’s Legislative Analyst’s Office estimated in 2017 that SB 562 would cost $400 billion annually. But new research out this week from UC Berkeley, UC San Francisco and UC Los Angeles  argues that single-payer health systems are a cost-saver in the long run.  

Authors looked at 22 different analyses of single payer plans over the last three decades. They found that 86 percent of them saved money in the first year, and 91 percent saw savings in the long-term. 

“This study underscores that, as opposed to increasing costs, all the evidence supports saving, most significantly associated with medication savings,” said Michael Rodriguez, a UCLA professor and report author. He noted that reduced administration costs are also a significant factor. 

The study did not take into account one-time transition costs associated with changing systems. 

Newsom’s commission marks the second time California health experts have gathered to discuss reforming the state’s health care delivery system. After shooting down the single-payer proposal, Rendon convened the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage to discuss ways to insure more residents. 

The committee held several hearings and ultimately released a final report recommending many of the changes that Newsom implemented last year.