Single-Payer Bill: Going Nowhere Fast

June 6, 2017

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Source: Los Angeles Times

Don’t delude yourself that legislation to create a California universal healthcare system passed the state Senate last week. All that passed was authorization to keep yakking about it in dreamland.

Or you can look at it this way: A fantasy-driven single-payer healthcare concept was given the equivalent of a grade-school social promotion. It should have been held back for a lot more work but was advanced undeservedly to the next level.

The goal of the bill, SB 562, is to establish a state-run healthcare system that covers all 40 million Californians, including roughly 2 million who migrated here illegally.

There really aren’t any details, but as envisioned, it would replace all private and government insurance, including senior citizens’ Medicare. Right there, the bill’s advocates should stop. Federal Medicare works fine. Leave it alone.

The California concept is promoted as “Medicare for all,” except it wouldn’t be Medicare. And it wouldn’t include Medicare’s ability to buy extra service through a private plan.

No one can be sure of anything, however, because this is a hollow bill — a bill in name only.

The legislative authors, Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), promised to keep trying to mold a real bill.

No one even knows the bill’s price tag. But whatever it is, it’s astronomical.

An analysis by the Senate Appropriations Committee, chaired by Lara, pegged it at $400 billion annually. To put that in perspective, total state spending for the next fiscal year is projected to be $290 billion, including $107 billion in federal dollars.

Lara says Californians currently spend $367 billion each year on healthcare — federal, state and private money. His bill would use that money, eliminating private insurance. There’d be no patient co-pays or deductibles.

The California Nurses Assn., the bill’s loudest advocate, paid for a University of Massachusetts Amherst study that picked a $331-billion cost. Lara is running for state insurance commissioner with the nurses’ backing.

Even if the state gobbled up all the government and private money being spent on healthcare in California, there’d still be a need for a state tax increase of up to $100 billion. A 15% payroll tax is envisioned. The nurses also suggested business and sales tax hikes. Lots of luck with that.

The rationale for passing a shallow bill devoid of substance was that June 2 was the deadline for a measure to be approved by its original house.

“The way the rules work in the Legislature, we are deadline-driven,” Sen. Bob Hertzberg (D-Van Nuys) argued during the long floor debate. The bill certainly has “many holes,” he said, but it should be kept alive and moved to the Assembly for negotiation and fine-tuning.

Except, the deadline argument was a poor excuse for the Senate not doing its job. Most legislative deadlines, like this one, are of the Legislature’s own making. And the deadline can be suspended on a two-thirds vote — the same vote that would be required to pass a substantive bill with a funding plan.

There would be a hard deadline Jan. 31 for Senate passage. But even after that, the proposal’s substance could be amended into legislation with a different bill number — a common “gut and amend” tactic.

So what the Senate did was disappointing and rather shameful if you’re a single-payer advocate. Rather than digging in and developing an actual plan, it passed the chore over to the Assembly, which hasn’t shown much interest in the subject.

“This is the most difficult issue I’ve ever agreed to work on,” Atkins told the Senate. “Let me assure you I’m serious about it. This is the biggest issue the state of California has undertaken in a very long time.”

Then you’d think it would have warranted more time and energy. But, realistically, it’s probably an impossible task given the complexity, competing interests and politics.

The bill passed on largely a party-line vote, 23 to 14, with most Democrats for it and all Republicans against. Because it didn’t include any funding, only a simple majority vote was required.

Give four Democrats credit for refusing to support it: Sens. Steve Glazer of Orinda, Ben Hueso of San Diego, Richard Roth of Riverside and Richard Pan of Sacramento. Glazer voted “no.” The others abstained.

“We should keep it here and finish the work,” Glazer said, “then put it on the ballot in 2018.”

“This is the Senate kicking the can down the road to the Assembly and asking the Assembly to fill in all of the blanks,” Hueso said. “I don’t see this bill coming back from the Assembly. I think this bill will die in the Assembly.”

Republicans brought up some practical problems for the bill. Start with the fact that California is only a state, not a nation. It would be almost impossible for one state to enact a single-payer system by itself.

And California’s anti-Trump Democratic legislators would need the Republican president to generously turn over federal Medicaid and Medicare funds to make their single-payer dream come alive.

“We give Trump crap day in and day out, and we’re going to beg him for a couple hundred billion dollars?” Sen. Tom Berryhill (R-Modesto) asked.

Anyway, even if the Legislature did manage to pass a bill, Gov. Jerry Brown probably would veto it. He’s very skeptical about the financing.

We’ll be watching what the Assembly produces. Maybe they’ll surprise us. But probably there’ll just be more yak.

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