First to Reject Another Rejection (Updated)

On Friday the state of Nevada became the first state [ed. see update below] to reject a single-payer plan. The legislature enacted a curt four-page plan to become active in January 2019, briefly summarized as “Medicaid for all”. Nevada’s governor vetoed it. The Fiscal Times relates:

While praising the Democratic “Medicaid for All” legislation sponsored by Assemblyman Michael Sprinkel, Sandoval said he ultimately concluded that there were too many unanswered questions about how the program would work.

The governor wrote that the bill was “an undeveloped remedy to an undefined problem” and that it hadn’t received proper scrutiny before it was passed in a short time frame.

They go on to elucidate:

However, there were numerous obstacles and stumbling blocks to getting the program up and running by January 2019, the target date for the start-up. The bill required Nevada officials to obtain permission from the Department of Health and Human Services to move ahead with the plan, but with no guarantee, the Trump administration, which favors rolling back Medicaid, would go along with the experiment.

The sketchy bill provided no hint of how much the new program would cost the state and the federal government, or how much the premiums and related copayments might cost – although presumably far less than market rate coverage.

Vermont has already put aside a proposed plan without it ever reaching the legislature. California is presently considering such a plan but that hasn’t assumed the form of a concrete bill yet. There are various other states with such programs in various stages of consideration.

Put on your prediction togs and make some predictions.

1. How many states will consider single-payer laws?
2. In how many states will they actually be enacted and signed into law?
3. In how many states will they be rejected, either by the legislature or the governor?

I think that most of the states, possibly all of them, will bandy around about statewide single-payer programs and one or two of them might actually pass such a law and have it signed by their governors with California and New York being the most likely candidates. I think that such laws will be rejected by nearly all of the states considering them, either failing to pass the legislature or being vetoed by their governors including in some of the most progressive states in the country.

I’ll answer another question, too. I don’t think that rejection by the states will dampen the fervor of those supporting it for a national single-payer system.

I supported a national single-payer system for years (after my experience in Germany). I think it’s an idea whose time has passed. Health care just costs too much now for any such system at any level to be practical. Costs must be forced down and that will be terribly difficult and painful to do. Which is why taking that necessary step will be resisted.

Update

I have been informed that Colorado voters rejected a statewide single-payer plan by 80%.