(Note: The writers address the question, “Should states create their own single-payer health care system?”)
SANTA CLARA, Calif. — Everywhere you look it seems another state has a single-payer health insurance proposal.
New York, Maryland, Nevada and Alaska have all put universal health care on the agenda. And now California, home to one of the lowest rates of people without health insurance in the nation, is seeking to take that rate to zero.
A slate of legislation from California’s State Assembly — 14 bills in total — seek to provide coverage to the 1 in 14 Californians currently uninsured. This week several bills passed to the Senate for consideration.
These bills are a means to insure all residents, while reining in health care spending.
Critics point to the high cost of “overhauling” the health care system as we know it, the threat of rationing and the loss of employer sponsored plans. These boogiemen are a distraction from the fact that health care markets operate like cartels: Their lack of competition reduces accessibility while maintaining high prices.
In California’s case, the benefits of the bills making their way through legislature are apparent — potentially cutting government expenditures on uninsured by half; insurance rebate incentives to increase plan participation; extension of Medi-Cal and the federal Covered California eligibility to individuals making 400 percent of the poverty level; and including all qualified individuals irrespective of immigration status.
This is hardly a wild, experimental “overhaul” of health care that critics fear: The bills would expand existing programs to cover the remaining Californians who are not eligible for other affordable insurance options.
Even if California’s bills resulted in state or federal government picking up all premium and out-of-pocket costs for those populations, that’s still half the $200 billion that the state and federal government currently pay each year for uninsured or underinsured Californians.
The hard truth is that market failures in our health care system exist, causing mass subsidization of the system that serves profiteers over patients.
Despite their capitalistic creativity, insurers have not found a way to profit and compete for all consumers. The reality is that, relative to insured consumers, uninsured Californians underutilize lower-cost primary care and preventative health services while overusing high-cost emergency interventions.
At the same time, swollen insurance billing bureaucracies and pharmaceutical advertising budgets of insurance companies trying to increase market share create myriad waste and inefficiencies unrelated to health outcomes.
Defenders of privatized health care routinely fail to address the poor relationship between care costs and outcomes in America.
A new system is needed. We have a collective nostalgia for the health and retirement promises that firms made to their employees in the 20th century.
That nostalgia is misplaced. Union membership is at all-time lows. Employment gains in the service economy fail to provide full-time hours and benefits. Even industries that provide full-time work are continuously renegotiating benefits packages.
These dynamics suggest that health plans tied to our workplace will continue to erode as costs increase. Nostalgia plus benefit erosion is why consumers pay cartel prices for care.
And while California is on sound legal and constitutional footing to give single-payer care a try, legislators who support it will need to fight hard to surmount significant political hurdles.
While California’s state Constitution allows for single-payer system programming, current proposals create no new programs and focus largely on expanding eligibility for existing programs like Covered California.
However, current constitutional spending guarantees would prohibit new tax revenues being used solely for health costs. Meaning that even if the state had the money to buy health care for all, any revenues deposited in the general fund would have to be used for other programs.
A vital step to making single-payer a reality, then, would be a successful ballot proposition designating a “health care only” revenue fund.
Until then, the current package of bills is a good step in the direction of insurance for all.
Matt Lesenyie is a post-doctoral fellow at Santa Clara University teaching California politics. His extensive government experience includes working for former Gov. Arnold Schwarzenegger. Readers may write him at 500 El Camino Real, Santa Clara, CA 95053.