Why single-payer health care in California remains elusive

from Dan WaltersCalMatters

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Is there a path for California to create a universal health care system, one with benefits paid through a “unified financing system” that pools federal and state funds with costs now borne by employers and — possibly — a new layer of taxation?

The answer seems to be that while such a path is possible, navigating it through the thicket of health care economics and politics would require dozens — or even hundreds — of hard choices.

This is the essence of a 181 page report by a team of researchers at the University of California, which was tasked with determining the factors that must be addressed before such a system can be implemented.

On Wednesday, the research team, hosted by UCLA’s Center for Health Policy Research, outlined the report’s findings and fielded questions during a webinar. His answers on the specifics of a unified system generally boiled down to maybe yes, maybe no.

In other words, someone or some entity would have to sift through the seemingly countless variables cataloged in the report and decide which ones to include and which to exclude.

These variables start with the overall approach. Will it be a “single-payer” system where the state funds medical services for every Californian, similar to the systems in the United Kingdom and parts of Western Europe? Or will it be a hybrid that retains some aspects of the current system?

Will the state pay current private and public health care providers or create its own network? Will the payments be fee-for-service or encompass the managed care system that currently dominates health insurance?

Would the federal government, which now pays roughly half of California’s health care bills through Medicare, Medi-Cal and various federal worker programs, be willing to give the state those many billions of dollars for a unified system? How would undocumented immigrants — now ineligible for federally funded services — to be processed?

The report generally argues that a single-payer system, by eliminating paperwork and other aspects of the current system, would be most cost-effective. However, this would probably be the most difficult version to create from a political point of view.

Single payer would be a holy grail achievement for the political left, both in California and on a national scale. The current search for some form began eight years ago when Gavin Newsomwho was then running for governor, said he was “sick of politicians saying they support single-payer but it’s too soon, too expensive, or someone else’s problem,” thus vowing to pursue it.

Once elected, however, Newsom moved away, eventually calling single-payer “an ambitious” rather than a difficult promise, and sought to gradually expand coverage through Medi-Cal and other programs.

But he signed legislation in 2019 to create a commission to study the issue, saying, “As our march toward universal coverage continues, I’m calling on the brightest minds — from the public and private sectors — to serve on the Healthy California for All Commission to improve our state’s health.”

The report of the commission for 2022 endorsed a “unified funding system” but did not specify a single-payer system. This led to the transition in 2023 Senate Bill 770 which, among other things, called for a UC study on alternatives that was released in April.

In a way, the question has turned around. When Newsom introduced the idea of ​​a single-payer system in 2018, anyone familiar with the state’s massive, very expensive and multi-player health care system also he knew that fundamental change would be very complex and very difficult.

The UC report says the same thing, only in more detail. Newsom managed to avoid making those tough decisions and will soon leave, possibly for a presidential campaign. Will the search continue on its way? Or was it just a theoretical exercise?

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.