Single-payer healthcare in California is out of reach. Universal healthcare is a better bet

After all the scuffling over single-payer healthcare legislation, the author mercifully killed the bill himself. It was smart — the only possible move that made sense.

If he had pushed for a vote on the Assembly floor, the measure would have gone “down in flames,” Assemblyman Ash Kalra (D-San Jose) told angry supporters in a Zoom call after he allowed the bill to die peacefully.

He hoped to leave open the possibility of a resurrection next year in a new Legislature.

He didn’t tick off lots of Democratic lawmakers by forcing them to go on record voting “no” or abstaining on the single-payer issue, which has become a holy grail for Democratic leftists — or so-called progressives.

If the outcome were looking close, then putting lawmakers on the spot would have been fair game. But Kalra says the measure, AB 1400, would have failed by “double digits” — despite its needing only a simple majority 41 votes and Democrats holding a supermajority 56 seats.

But the California Nurses Assn., the bill’s zealous sponsors, wanted to take names and kick behinds of Democrats who voted against single-payer. The politically active group intended to impose punishment at election time.

After the nonvote, the union declared it was “especially outraged that Kalra chose to just give up.”

CNA President Zenei Triunfo-Cortez told me that more than 300 AB 1400 supporters were watching the Assembly floor live on big screen TV, waiting for the debate and vote.

“What we wanted to do was to see who was really solid and who was not, so we would know who to work with and who not to reelect into office,” the CNA leader said. “Those who were against single-payer, they are not worth being reelected.”

The California Democratic Party’s Progressive Caucus also threatened to withhold endorsements from Democrats who voted against single-payer.

So the only logical response was to call off the vote when the bill was destined to fail miserably.

Kalra explained to me: “Going down by double-digits, it would have done irreparable damage.”

Many lawmakers who wouldn’t have voted for the bill still could be persuaded to support future legislation, Kalra said.

But once a bill is blown out, he noted, “It’s harder to get them on board. They will have exposed themselves. And they will have won reelection not having voted for single-payer. That hardens their position.”

Kalra said he expects at least 15 new Assembly members next year and believes many will be open to voting for a new single-payer bill.

But it’s hard to imagine any Legislature more liberal than this one, with Democratic supermajorities in each house.

One big political problem for single-payer is that it’s single-payer.

And it’s not Medicare-for-all. It’s Medicare-for-nobody.

It’s called single-payer because only one entity — state government — would pay providers for healthcare. Insurance companies would be booted aside.

Californians would be switched from their current coverage — whether private, federal Medicare or Medi-Cal for the poor — to a new state-run system that was called CalCare under Kalra’s bill.

The goal is to cover everyone and reduce healthcare costs by eliminating private insurance profit and negotiating lower provider fees and drug prices. Under CalCare, there would have been no premiums, co-pays or deductibles.

But it would have required the largest state tax increase in history, estimated at $163 billion. It would have cost up to $391 billion annually. And Washington would have needed to turn over to Sacramento all the federal Medicare and Medi-Cal money it now spends in California.

All that’s mind-boggling.

But here’s one simple stat that’s a huge obstacle to public acceptance of any state-run single-payer program: There are more than 6.5 million Californians on Medicare. And they seem reasonably happy with it.

Medicare recipients are primarily seniors 65 and over. They’re high-propensity voters. And the ones I know wouldn’t like the state meddling with their healthcare. They’d be nervous about being forced into a system run by Sacramento, which tends to fumble the ball.

“They’re not going to want to give up something that they’re satisfied with for something that’s unknown. If my car is working and I’ve got no problems with it, I’m not motivated to get rid of it,” says Assembly Health Committee Chairman Jim Wood (D-Santa Rosa).

Wood, a dentist, says he would have voted for AB 1400 “to keep the conversation going about the challenges and faults in our current healthcare system.”

“Medicare is a good program. That’s why people use ‘Medicare-for-all’ as a slogan” for universal coverage, says single-payer supporter Anthony Wright, executive director of Health Access California, an advocacy group.

“There are some real obstacles” to single-payer, Wright says: “Financing, getting federal approvals, ideological opposition, medical industry opposition. We need to be clear-eyed about these obstacles in order to overcome them.”

It’s also virtually impossible to pass legislation this revolutionary without hefty promotion and pushing from the governor. Newsom sat out this failed fight, although he ran for governor as a strong backer of single-payer. Since then, he has apparently been indoctrinated in political realism.

Newsom is moving toward universal healthcare on his own by proposing that all low-income-qualified Californians be covered by Medi-Cal regardless of their immigration status. The last undocumented age group not under Medi-Cal is 26 to 50.

The governor also created a commission to develop a broad plan for universal healthcare. The panel hopes to report in April.

Single-payer seems out of reach. But universal coverage is close.

Meanwhile, Kalra saved everyone from wasting time and needless brawling.

For the record:
11:29 a.m. Feb. 3, 2022: An earlier version of this column stated that Anthony Wright was the executive director of Healthcare Access California. He is the executive director of Health Access California. The column also said that 1.6 million Californians are enrolled in Medicare. More than 6.5 million Californians are enrolled in Medicare.

This story originally appeared in Los Angeles Times.