Universal Healthcare: A California Pipedream?

  • Poage, Jeffrey, MD
| Feb 12, 2018

In 2017, Senate Bill 562 was introduced by Senators Ricardo Lara (D-Long Beach) and Toni Atkinson (D-San Diego). The bill was sponsored by the California Nurses Association and called for the enactment of the Healthy California Program to oversee comprehensive universal single-payer healthcare coverage for all California residents.

A report issued by the Senate Appropriations Committee indicated the cost of implementing SB 562 was $400 billion per year – over twice the current State budget of $183 billion! The bill was passed by the Senate last June but shelved in the Assembly by Speaker Anthony Rendon who criticized the plan as being “woefully incomplete”.

RoseAnn DeMoro, Executive Director of National Nurses United, blasted Rendon for his decision and said he was sabotaging Democratic-led efforts to implement a “Medicare-for-all” type system. According to the Sacramento Bee: Supporters of SB 562 have been highly critical of Rendon’s approach, suggesting that he killed the single-payer proposal to protect health insurance and pharmaceutical companies that contributed to his campaigns. They’ve held numerous protests at the Capitol and even launched a recall campaign against him, though it has yet to gain traction. Rendon said he also received over 100 death threats for his decision.

Many state legislators support the concept of universal healthcare but have concerns about how to pay for it. According to a survey from the Public Policy Institute, two-thirds of Californians supported a single payer system until they learned the plan would raise their taxes – then support fell dramatically. This being, of course, prior to the passage of the new Federal Tax Bill which will no longer allow Californians to deduct the full amount of their State and Local Taxes (SALT) and mortgages from their federal income taxes.

A legislative analysis by the Senate Appropriations Committee suggested a price tag of $400 billion for SB 562. Proponents have argued that half of the dollars would come from increasing gross business taxes and the other half from a payroll tax increase. The nurse’s union commissioned their own analysis by UMass Amherst which yielded a slightly lower number of $330 billion, with equal revenue from new sales and business taxes in combination with repurposed Medicare and Medi-Cal funds. Regardless, SB 562 is NOT free healthcare.  And the means to achieve funding has not been fully vetted.


In addition, the proponents of a single payer system face three formidable obstacles:

  • Gubernatorial approval:  Governor Brown has voiced concerns about SB 562.
  • Voter approval to bypass current State spending limits:  Is a Proposition for the November ballot in the works?
  • Federal Waiver to repurpose Medicare and Medicaid funds:  Would the Trump Administration be willing to give California the green light?

The discussion regarding a single payer system is not going away. It will be front and center as the 2018 election cycle revs up. Lt. Governor Gavin Newsom, the current front-runner in the gubernatorial race, claims the only thing stopping single-payer California is a lack of political leadership. Newsom, of course, was successful in bringing universal coverage to the city of San Francisco during his tenure as mayor. The program, Healthy San Francisco, was instituted over ten years ago. By definition, it is not truly “insurance” as it is not portable outside San Francisco and you must have no other options for coverage.

Recently, the California Medical Association has launched a new coalition of more than 100,000 health professionals, including Kaiser Permanente, California Orthopedic Association, CalACEP, and the CSA, to actively oppose SB 562 stating simply, “it would dismantle the health care marketplace and destabilize California’s economy.  We are disturbed that the current federal and state health care debate is disconnected from practical realities that providers experience in communities throughout California.”  For more information, go to https://www.protectaccessca.org.

The Coalition believes in the following principles:

  • Aggressively protect and expand access to health care by building upon the successes of the Affordable Care Act.
  • Work to expand access to care to the remaining 2-3 million Californians who are still without coverage.
  • Oppose efforts to repeal or undermine the Affordable Care Act.
  • Oppose Senate Bill 562 or any other health care proposal that destabilizes California’s health care system by calling for unrealistic revenue increases that could destabilize our state budget.
  • Commit to improving and expanding care for all Californians through an approach that builds upon California’s existing health care delivery system.

Bottom line: CSA will be coordinating with our House of Medicine peers to effectively advocate on this high-profile issue moving forward. Brace yourself for more rhetoric on single-payer universal healthcare in the coming year. In fact, be prepared for some form of legislation to actually pass the Senate and Assembly.  And as is often the case in politics, logic and common sense need not apply!

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