Single-Payer Health Care for California: It’s Time
On Monday, the California Assembly is poised to vote on the Guaranteed Health Care for All Act (CalCare), AB 1400, which could bring the state one major step closer to enacting real universal care for all Californians.
This legislation has drawn support from the cities of Los Angeles, San Jose, Sacramento, San Francisco, and Long Beach (but not San Diego), along with California Nurses Association/National Nurses United, Public Citizen, the California Democratic Party, the California Labor Federation, Indivisible CA: State Strong, and more than 60 other organizations.
The campaign to kill the bill, whose opponents include California Chamber of Commerce, the California Hospital Association and the California Medical Association, is already underway. If you saw or heard the ads, you know they are saying this will amount to the largest tax increase, ever.
[Insert doom and gloom predictions about a massive exodus of businesses and the cream of the workforce fleeing the state, probably for Texas, where reproductive services are restricted, but guns are not.]
Don’t tell anybody, but businesses would have 1.25% of their payroll on health coverage — down from the current average of 9%.
The naysayers' objections focus on perceived cost rather than the devastating medical bills and the mountain of debt and other barriers to care imposed by the industry. But studies show most Californians would pay less under CalCare than they do now for health coverage.
There are details –tons of them– that I haven’t completely vetted and won’t until the State Senate gets its turn. The basic bill is this:
AB 1400 would allow every resident of California - regardless of immigration - status, to enroll in CalCare.
There would be no cost to enroll, nor any responsibility for members for any out-of-pocket costs for covered services.
A nine-person board would be appointed by Gov. Gavin Newsom and other politicians to run CalCare and set pay rates and fee structures
There is no guarantee Gov. Newsom will sign it – he’s officially neutral. The healthcare industry stepped up big time when it came to contributing money to fight the failed recall campaign, and the Gov. now talks in terms of universal coverage rather than single payer. The former would maintain the status quo of the insurance/pharma/medical industry, the latter would see it replaced by a single entity.
If AB 1400 is approved, the funding mechanism, the funding mechanism for the bill (AB 11) will ultimately be up to voters to be approved by a supermajority, and we’re at least two years away from that happening. Should one fail, neither measure would be implemented.
ACA 11 would raise taxes on both businesses and individuals
It includes a 2.3% tax on businesses that gross more than $2 million annually in revenues, a 1.25% payroll tax on businesses with more than 50 employees, and an additional 1% tax on businesses where employees make more than $49,900 annually.
Individuals making more than $149,509 in taxable income would see an additional 0.5% tax, with the tax rate progressively increasing to 2.5% of taxable income for those individuals making more than $2.48 million annually.
UPDATE: I’d like to say something like great minds think alike, but in this case I’m sure it’s just a coincidence. Here’s a snip from Cory Doctorow’s daily essay at Pluralistic:
Now, that number might seem like a big one, but as Sonali Kolhatkar writes for Naked Capitalism, it actually represents a savings for taxpayers, businesses and the state as a whole. For starters, the median Californian will pay $1,000 annually for CalCare, far less than even the cheapest health-care plan (and those cheap health-care plans cover far less than CalCare, and impose a far higher red-tape burden).
All told, Californians pay $391b/year for health care, and that's with 2.7m of us left completely without coverage. AB 1400 will zero out all that spending, and replace that system with a $314b universal program (with better benefits!) that will save the state and its residents a whopping *$71,000,000,000* every single year, *forever*.
Who could possibly object to this system? You guessed it: the health insurance monopolists, who, with their allies in the California Chamber of Commerce, called AB 1400 "a job killer." This despite the fact that it will save companies - especially small businesses - a fortune in administrative overheads for health-care, while making their employees healthier and less precarious.
Far from being a job killer, AB 1400 will be a job creator, making it easier for employees to quit their jobs and start independent businesses without fear of medical bankruptcy, and removing barriers that prevent employees from quitting bad jobs and taking better ones for fear of losing access to the specialist health-care they or their family rely on.
For the Chamber of Commerce, the fact that employees can't quit bad jobs and start new businesses is a feature, not a bug. Tying health-care to employment creates leverage for employers over their employees, allowing them to suppress wages and silence complaints about toxic and dangerous workplaces. The Chamber doesn't represent all California businesses - it represents the state's oligarchic and monopolistic giants, for whom the administrative burden of healthcare is a small price to pay for a tame workforce and high barriers to entry for upstart competitors.
According to a Jan. 6 news release from Assemblyman Ash Kalra, 57% of Californians supported replacing private insurance with a single-payer system.
(UPDATE) Two-thirds of the legislature has to agree, then it goes to the voters.
It’s going to be a tough sell, and if the rideshare industry’s tsunami of bullshit ads over Proposition 22 was any indication, single payer advocates will have to bring shovels. A winning argument will one that establishes beyond a doubt that the vast majority of people and businesses will pay less.
I think arguments about the quality of healthcare have mostly refuted themselves, thanks to the industry supported consolidation of hospitals and Wall Street-led over financialization of things like Band-Aids. COVID has forced Americans to take a closer look at the business of healthcare, and it hasn’t been a pretty picture.
A look at the bigger picture from MarketWatch:
The stress of the pandemic on the health care system is evident. And a new report concludes that the U.S. ranks last compared with 10 other high-income countries when it comes to health care.
“The United States trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes,” a report from The Commonwealth Fund reads. The Commonwealth Fund is a private U.S. foundation aimed at promoting better health care access and quality, particularly for the vulnerable and disadvantaged.
The U.S. has ranked last in all seven studies the Commonwealth Fund has conducted since 2004…
…The report’s authors considered five measures: access to care, care process, administrative efficiency, equity and health care outcomes.
The U.S. ranks last in all of the measures, except for “care process,” for which it ranks No. 2.
Though the U.S. ranks last overall, it also spends the most as a percentage of its GDP on health care. In 2019, the U.S. spent 16.8% of its GDP on health care, while Switzerland, the next highest, spent 11.3% of its GDP.
There is also wiggle room for advocates. A survey from the California Health Care Foundation (CHCF) found that 49% of Californians skipped or postponed needed care because of cost in the last 12 months, and 47% of those say their health worsened as a result. A quarter of all Californians reported someone in their family had trouble paying medical bills during the same period.
Opponents to single payer in California are trotting out arguments like:
“It will force all 40 million Californians into a new untested state government program and will prohibit them from being able to choose private coverage even if they want it.”
While hospital systems and insurance companies will produce ads with a lot of doctors aiming at causing doubt about the quality of care under single payer, the reality is that a recent vote at a American Medical Association meeting indicates that the most hard core opponents are losing ground. A resolution put forward by the medical student chapter to end the AMA's opposition to single-payer health care garnered 47% of the yes vote.
Ultimately we need to accept reality, namely that the caring part of healthcare has been subordinated to the greed of corporate executives. Nobody likes to have stuff taken from themselves, and the industry’s ultimate ploy will be to convince voters that patients will be the victims here.
Here’s to hoping they don’t succeed
Email me at WritetoDougPorter@Gmail.com