Single Payer in California

I hail and welcome California’s attempting to institute a single-payer health care insurance system in the Golden State. US News reports:

This week the Trump administration encouraged governors to use the framework of President Barack Obama’s health care law to craft plans that meet their residents’ unique needs, stressing that the federal government is set to usher in a new era of flexibility in health care.

In California, lawmakers are going to see how far they can push these calls to action: They plan to put forth a health care bill that would offer a single-payer system to guarantee coverage for all Californians, regardless of their immigration status.

The proposal is still being fleshed out, but it likely would require significant funding from the Golden State, and previous efforts to implement a single-payer measure have failed there and in other states. The move comes at a time when fierce opposition to the Trump administration has escalated following the president’s executive actions on illegal immigration and a battle on Capitol Hill to overhaul the health care system.

Canada’s health care system was not imposed by its federal government; it rose from the provinces and continues to be administered by the provinces. Could it be that state-based health care reform has more potential than a federal program?

Success in California could also lead to other states adopting their own reform plans. It will be an interesting experiment.

5 comments… add one
  • Jan

    How would CA finance it’s single payer program? Higher taxes? And, what will happen when more of the over-taxed population leaves the state? Who will bear the costs?

  • steve

    I wish that some of the red states would try to implement the market based reforms they want to impose upon the whole country.


  • Andy

    Well I wish them luck, but I think the sticker shock will be much too big. The simplest way to get single payer in a state is probably to just open Medicaid to everyone and then pass legislation requiring all providers to accept it. Currently, about 1/3 of Californians are already on Medicaid and that costs about $90 billion a year. So a WAG for expanding it to everyone would be about $180 billion a year more. Google tells me the current total budget is about $250 million.

  • Andy

    That should be $250 billion, not million.

  • CuriousOnlooker

    I definitely think so; I made the argument before along these lines. The biggest pro for state led reform is it political sustainability aspect; it provides a way for the country to do incremental reform while reforming wholesale, try different approaches, and account for local conditions.

    By the way – Canadian style single payer is not making all providers accept Medicaid; its forcing all providers accept Medicaid only.

    The financial cost and the taxes to pay for it is not the barrier to single payer. In Canada, health care spending accounts for half to more then half of the provinces budget, despite provinces having more responsibilities then states. Canadian columnists joke in jest that the provincial government are HMO’s that happen to have side businesses.

    If total health care spending stayed the same or decreased after single payer, then the new taxes would be fully offset by killing insurance premiums. That’s the real key, as Dave talks about all the time, can any reform (including single payer) reduce health care spending more then the current system.

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