Patterico's Pontifications


Single Payer Health Care in California Fails (For Now)

Filed under: General — JVW @ 7:09 am

[guest post by JVW]

CalMatters has the details:

Despite, or perhaps because of, an aggressive last-minute push by progressive activists ahead of a crucial deadline, legislation to create a government-run universal health care system in California died Monday without coming up for a vote.

The single-payer measure, Assembly Bill 1400, was the latest attempt to deliver on a longtime priority of Democratic Party faithful to get private insurers and profit margins out of health care. Because it was introduced last year, when it stalled without receiving a single hearing, it needed to pass the Assembly by Monday to continue through the legislative process.

But even the threat of losing the party’s endorsement in the upcoming election cycle was not enough to persuade the Assembly’s Democratic supermajority to advance the bill for further consideration, effectively killing the effort for another year.

Thanks to a generally strong stock market and performance of the tech sector during the COVID lockdowns the state is awash in tax revenue, so much so that some of it will likely even be returned to the taxpayers in rebate form after the May budget revision leads to the legislature probably passing a budget in June, just in time for Governor Newsom to start his summer reelection tour. It’s therefore unsurprising that hyper-progressives who have a strong presence in the legislative Democrat caucus are pushing for the state to once-and-for-all take over the burden of ensuring that all Golden State residents, irrespective of their citizenship status or even the legality of their presence here, be covered by a mandatory state-run health insurance program. Then-candidate Newsom came out in favor of single-payer health care for California during his 2018 campaign, but since then has suddenly become quiet on the issue, remaining mum on AB 1400 while grousing that the bill’s sponsors had not shared their plans with his office.

That bill’s main sponsor, Ash Kalra of San Jose, predictably blames his failure to get at least 41 of his 56 Democrat colleagues to vote to advance this bill in order to keep it from expiring (it was first introduced almost a full year ago). Assemblyman Kalra acknowledges that he fell short by “double-digits,” suggesting that as few as half of his caucus supports a Sacramento takeover of healthcare. To be sure, AB 1400 wouldn’t have immediately implemented single-payer from Chula Vista to Crescent City; the all-important financing of the program at an estimated tab of $200 billion per year would still have to be hashed out, both with those employers who currently purchase health insurance on behalf of their employees and with Washington DC, who remits to California its annual share of Medicare and Medicaid funds. But the bottom line to progressives is that passage of the bill would have made socialized medicine in the Golden State a fait accompli, and the bill called for the particulars of the program to be hammered out by a state-appointed board and approved by the legislature no later than July 1, 2024.

The move to single payer exposes a fissure within the dominant Democrat majority. The quite powerful and excessively left-wing California Nurses Association is the prime mover of this legislation, but other public employee labor unions which have worked hard to negotiate first-class health care coverage for their members (think teachers, for example) might not be too keen to be dumped into what will certainly end up being no better than a “MediCal for All” system. It’s this sort of intra-party squabble which, among so many other things, doomed native daughter Kamala Harris’s Presidential bid back in 2019.

There’s no doubt that the Democrats are sure to bring back this bill once Gavin Newsom is safely reelected. Look for him on the campaign trail to reiterate his desire for a statewide single-payer program in order to shore up his support among the Sanderistas in this state who are threatening to withhold support from Democrats who refused to back AB 1400, while at the same time issuing enough caveats about the cost of the bill and the future of the state’s finances to placate status quo Democrats who don’t want to lose the good thing they have going. In the end, expect Gov. Newsom to push forward with a single-payer plan, since that could truly shape up to be the only possible lasting legacy that this massive narcissist could leave. Naturally, he will want it to be fully implemented before he leaves office in January 2027 (jeeze, that’s a long time from now). And, of course, once California Democrats venture down this road, the rest of the national party won’t be too far behind.


31 Responses to “Single Payer Health Care in California Fails (For Now)”

  1. Newsome will run for President, just like Jerry Brown did. Passing single payer would give him the street cred among the Progressives to forgive him for being a white male.

    The Wean Corps (7e8b78)

  2. Too bad about single payer. I can think of no initiative so likely to destroy the Democrat lock on California as that. Between the doubling of the state tax burden, the outlawing of employer-paid health insurance, forcing everyone into what is essentially Medicaid, and taxing retirees, again, for other people’s medical insurance (this time with no promise of future benefits), it would have pissed off nearly everyone except the poor and/or illegals (whom it surely would have covered).

    But they aren’t that stupid.

    Kevin M (38e250)

  3. One note that complicates this: Medicare funds are not funneled through the state of California, but are paid directly by the federal government to providers. How THAT would be handled is unclear (I expect that Medicare would remain unchanged, as a separate single-payer system, complete with private insurer add-ons).

    And good point about government workers not wanting their “negotiated” gold-plated health plans turned into common-denominator MediCal. I think they usually vote Democrat, too.

    Kevin M (38e250)

  4. The recent (and continuing) stock market collapse should cut into those tax revenues. Also, enactment of single payer was contingent on voters passing a constitutional amendment imposing an excise tax on business “for the privilege of doing business” in California, and two payroll taxes on employers, thereby reducing the number of employed in the State, as well as new income tax surcharges.

    The only business that can’t leave the state is the government. Everybody else can pack up and leave.

    Rip Murdock (d2a2a8)

  5. I received a text spam from the nurses association asking for support. I replied why would I support something that would add to my already high income tax burden and how can I expect that single payer could be implemented successfully by the same organization that runs the DMV.

    Rip Murdock (d2a2a8)

  6. If memory serves there was a single-payer referendum on the ballot here in CA back in 1996 or so, which failed. I voted for it but have since repented. It was a little surprising that single-payer failed in the legislature this year as the state is much bluer than it was then. But there may be more good sense left here than you would think from reading the LA Times. If Newsom tries to revive single-payer, perhaps asking people if they would like to ride the bullet train to a doctor’s appointment would be enough to defeat it.

    Less snarkily, as JVW points out, some reliably Democratic groups may not want single-payer because the health care plans they already have might suffer. Add Hollywood actors, directors and writers to that group. The entertainment industry health plans run by or for the various guilds provide services much better than what the average Californian can get. The entertainment industry unions will not want to jeopardize the health care they already have.

    RL formerly in Glendale (48bc71)

  7. Not to mention that nearly 50% of Doctors in CA don’t take Medi-Cal patients because of typical bureaucratic nonsense like paperwork burden and low reimbursements

    steveg (e81d76)

  8. Add Hollywood actors, directors and writers to that group. The entertainment industry health plans run by or for the various guilds provide services much better than what the average Californian can get.

    This is true, but I fear that Hollywood and Silicon Valley movers and shakers will simply go to other states and either purchase health plans there or else pay out of pocket for treatments that will otherwise be rationed in California. As Rip Murdock points out, businesses can easily relocate out of the Golden State. In a similar manner, that Hollywood producer or well-connected San Francisco stock broker can simply declare their Lake Tahoe home (on the Nevada side, naturally) or ski chalet in Aspen as their primary dwelling, and with the popularity of work-from-home these days they can spend 183 days per year somewhere other than California.

    JVW (ee64e4)

  9. Single payer can’t fail; it can only be failed.

    Hoi Polloi (7cefeb)

  10. What we all deserve to happen is for California to pass the single-payer plan in spring 2023, declare that it will go into effect on January 1, 2026, and then have a Republican Administration replace the Biden Administration in January 2025 and announce that they aren’t going to let California use Medicare/Medicaid funds in that manner. That would give us lots of blog about here; us Tenth Amendment conservatives will be tied into knots, as will all of the federal primacy fetishists on the left.

    JVW (ee64e4)

  11. If you carve out State and Local government workers, private sector union workers from the CA plan, who is left?,%2C%20up%201.6%25%20from%202010.

    In California, 15.4% of the workforce are employed by the government — either at the state, local, or federal level — the 19th lowest share of all states. Breaking with the national trend, the number of government workers in California has increased in recent years. There are currently 2,487,100 public sector workers in the state, up 1.6% from 2010.

    States with a larger than typical share of public sector workers often have higher than average government spending on a per capita basis — and vise-versa. California is an exception, however. Per capita state and local government spending in the state totaled $12,970 in 2019, compared to the $10,131 national average.

    15.54% Public workforce carve out plus 9.6% Private unionized work force carve out sort of puts a crimp in affordability with nearly 1/4 of the workforce not contributing to any new program.

    steveg (e81d76)

  12. I included Federal employees in my number, but you get the point

    steveg (e81d76)

  13. RL: Most employer plans beat the doors off of Obamacare plans (except the special no-copay Obamacare plans only available to those claiming a narrow income range (most are lying)). Not only union members and government employees, but professionals, many corporate employees and much of the remaining middle class has better plans than are offered through Covered California.

    The “Progressives” may think they are the base of the party, but they try this and they will get their heads handed to them. The actual base of the Democrat Party in California are the public employees and the working middle class.

    Kevin M (38e250)

  14. Private doctors may not treat MediCal, or even Obamacare, patients but the public hospitals and the excellent UC hospitals do. The best hospital in California is UCLA Medical Center in Westwood. Their charges for the uninsured are horrendous though.

    Kevin M (38e250)

  15. JVW (@10)

    Again, Medicare is not administered by the state. Even if they passed single-payer, there would have to be federal laws changed in order for them to access those funds (and this would not happen). So, it is unlikely that they could force Medicare patients into their system.

    They probably could not impact the Medicare add-on marketplace (Parts C, D and supplements) either, as that is also federally run, but they might make operations in CA too costly for the private insurers, so there were few such plans offered to CA residents.

    The real problem for Medicare recipients would be the new taxes they would be paying for something they don’t get (and would never get, unlike Medicare taxes). CA workers would probalby still have to pay the Medicare payroll tax, which could also be a bone of contention.

    Kevin M (38e250)

  16. California as well as other states have failed because of the cost structure to have fully covered healthcare for all its population. All civilized countries like canada and western europe have national healthcare for its people. The corporate democrats are hesitant to do their duty and bring national healthcare to america. Millions of americans have died because they could not afford healthcare. What is to be done. Their is no statue of limitations on murder. When AOC becomes president simply arrest those federal and state politicians and if necessary voters who voted republican for accessary to murder if not murder itself of those who died. Some years back before the federal government stepped in many children died because their parents could not afford treatment. I remember seeing pictures of children on glass jars begging for coins to save their lives while adults died without hope. Those who are responsible for preventing national healthcare can be arrested for murder at anytime.

    asset (2e7c16)

  17. Off your meds?

    Rip Murdock (d2a2a8)

  18. @17 not much of a retort. I expected better.

    asset (2e7c16)

  19. So it would seem that asset is even more unhinged than usual today. Gotta love the Stalinesque exhortation to arrest those who don’t vote for the program that the far left believes is a human right. If this is your attempt at trolling, asset, please just take the rest of the day off from the blog and come back when you are feeling better.

    JVW (ee64e4)

  20. When you vote to prevent people from getting healthcare then they could not other wise afford you are killing them. People i know died needlessly because they could not afford expensive treatment I am sure you know some too.

    asset (2e7c16)

  21. JVW #8. It may be different for the people at the top, but from my observations the vast majority of Writers’ Guild (WGA) members don’t have the option of easily moving out of state while still working here. The WGA health plan is really good, but WGA members are not guaranteed access to it, but have to have a certain amount in “covered” earnings each year because the plan gets a lot of its money from the contributions made by production companies. The result for most writers, i.e., not the very few lucky enough to have a staff job this year on a network show, is a constant struggle to maintain eligibility. I’ve heard any number of times of writers taking an otherwise unattractive freelance writing assignment because “it’s Guild” meaning that it will count toward them making the minimum needed for health plan coverage that year. None of these people are going to be OK with single payer if it means losing the health plan coverage they’ve worked so hard to get and maintain. On most issues, the WGA has two factions: the militant, and the even-more-militant, but neither will want to see their health coverage jeopardized.

    RL formerly in Glendale (48bc71)

  22. @16. Unlike those other nations, the primary objective of the h/c system in the U.S. is to be profitable; not deliver healthcare. Those citizens in other lands- particularly Europe- are taxed to finance their h/c systems, too– rather than fund a pricey military defense– which they’ve suckered America to do for them for decades. Which is why in part, they deadbeated NATO payments for years, rebuilt their social infrastructures instead– and have a quality of life better in Dusseldorf than Detroit.

    DCSCA (f4c5e5)

  23. It may be different for the people at the top, but from my observations the vast majority of Writers’ Guild (WGA) members don’t have the option of easily moving out of state while still working here. The WGA health plan is really good, but WGA members are not guaranteed access to it, but have to have a certain amount in “covered” earnings each year because the plan gets a lot of its money from the contributions made by production companies.

    Yep. Have a friend who is dealing with that right now.

    DCSCA (f4c5e5)

  24. Newsom?

    The guy who tells us to wear masks? – and he does not.

    The guy who slept with his best friend-campaign manager’s wife?

    The guy who allowed the $31 BILLION Cal EDD fraud debacle?

    Not to mention the fed’s $100 BILLION PPP debacle. Washington DC: Criminals have stolen nearly $100 BILLION in Covid relief funds

    Can you say DYSTOPIA?

    Here is dystopia in a picture.

    Missing A Package? Local News Crew Discovers Stolen Packages ‘As Far As The Eye Can See’ On Train Tracks | The Daily Caller
    A Los Angeles photojournalist captured video of a plethora of stolen packages. He shared the footage of the packages on the train tracks to his Twitter

    Single Payer? You cannot keep getting money from the feds forever and the feds cannnot keep printing it forever.

    Turns out most often, bigger is not only not better, but bigger does not work and too often the wheels fall off. Think. Afghanistan. Cal’s Bullet Train.
    Liberty & Truth require constant vigilance. GLZ.

    Gary L. Zerman (a1521c)

  25. When you vote to prevent people from getting healthcare then they could not other wise afford you are killing them.

    This is a very childish view to take — “if I need something then somebody ought to give it to me no matter how much it costs” — but there are millions and millions of Americans who join you in this nonsense. If you believe that countries which have single-payer health insurance don’t end up denying life-saving treatment to many of their citizens because of cost considerations, well, there’s very little hope that you will ever be disabused of your delusions.

    JVW (ee64e4)

  26. Attempts at “single payer” are yet another reason why I’m against taking away Trump’s adjustment to state taxes against federal ones. Other states should not subsidize these horrific policies.

    NJRob (cc7e2d)

  27. If you don’t have the money to pay for it you are also denying life saving treatment. Medicade saves some if you qualify ;but that veries from state to state in az they have access which is generally known as inaccessible. Most people are strategists they come up with a goal. I am a tactician I come up with tactics to achieve the goal. Others say we need healthcare for all, I say how it can be done.

    asset (a0cf07)

  28. Speaking of failing, the Biden agenda took a big hit yesterday with NM Senator Lujan’s stroke. He’s expected to make a full recovery — and I truly hope he does — but he’s laid up for at least a month, leaving the Senate balance at 50-49.

    Kevin M (38e250)

  29. Speaking of failing, the Biden agenda took a big hit yesterday with NM Senator Lujan’s stroke. He’s expected to make a full recovery — and I truly hope he does — but he’s laid up for at least a month, leaving the Senate balance at 50-49.

    Congress will need to vote on (yet another) debt limit increase by February 18 (two weeks from this Friday), so watch for the s***show to begin anew. I kind of doubt that Cocaine Mitch will be willing to give Schumer a clean bill, and Dems have to worry that Manchin (and possibly other Dems) might insist that BBB is laid to the grave once and for all before they agree to take on more red ink. Suddenly, the anticipated “big win” for Biden with a successful Supreme Court nomination might be offset with some pretty ugly losses to the rest of his agenda.

    JVW (ee64e4)

  30. I thought Breyer was not retiring until the end of this Supreme Court term. In June. Which gives Biden until the first Monday in October to have a new Justice sworn in.

    nk (1d9030)

  31. Hi KevinM

    I appreciate your point about public hospitals and the UC system hospitals and related professional healthcare.
    Was wondering why UCLA medical had opened an office here in town and it looks like they think there is a market for them here amongst all the concierge, no CoveredCA and no Medi-Cal practitioners

    steveg (e81d76)

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