Newsom Tamps Down Expectations for Single Payer
Gavin Newsom, favored to be California’s next governor, is campaigning on a progressive vision of single-payer health care whose viability could pose a major test ahead of the 2020 elections for Democrats wrangling over how to enshrine universal health coverage.
Newsom, 50, has long favored single payer and expanded health care while mayor of San Francisco. He isn’t shying away from that goal, which is increasingly popular with the activated progressive wing of the party but is proving a tough sell because of the exorbitant cost.
A single-payer bill failed in California’s Legislature earlier this year, in large part over a projected annual price tag of as much as $400 billion. On a smaller scale, Vermont had the same experience under former Democratic Gov. Peter Shumlin.
“He’s not going to deliver a single-payer-like health care system because it’s too expensive and there’s not a roadmap for it now,” said David McCuan, a political analyst and political science professor at Sonoma State University. Indeed, many political observers think Newsom will incrementally expand coverage, possibly starting with a first-ever Medicaid expansion to undocumented adults.
Newsom himself is already cooling expectations that he’ll blow up the status quo should he defeat Republican nominee John Cox. He recently told the San Francisco Chronicle that a single-payer system could take “years” to implement — a virtual certainty since it would require several approvals from the Trump administration.
“It’s not an act that would occur by the signature of the next governor,” Newsom told the newspaper. “There’s a lot of mythology around that.”
But Newsom hasn’t backed down on single payer as the ultimate goal. “I believe inevitably this country will end up with a single-payer financing system,” he told The Sacramento Bee editorial board in April. “This country either gets it right with Medicare for All, or this state leads this conversation in a way that ultimately advances that.”
Newsom shepherded San Francisco’s groundbreaking health care program that at its height provided more than 70,000 uninsured residents access to health care services, and he’s expected to be substantially more active on health policy than term-limited incumbent Democrat Jerry Brown. The results may reveal what is realistic as Democrats nationally try to make expanding coverage and thwarting Republican policies to undercut Obamacare a cause without dividing progressives and more-incrementalist backers of expanded care.
Newsom hasn’t said how he’d secure universal coverage — or how California would pay for it. In a gubernatorial primary victory speech after defeating former Los Angeles Mayor Antonio Villaraigosa — who derided the single-payer push as “snake oil” — Newsom called for “guaranteed health care for all” and promised policies with “bolder colors and bigger ideas.”
“People have put the Democrats totally in control of the state of California, and they expect action,” said Garry South, a longtime California Democratic political strategist. “If our health care system starts to disintegrate because of actions taken by the Trump administration or congressional Republicans, there’s going to be no one to blame but Democrats in California. They’ll say, ‘You should have seen this coming.’”
Newsom’s campaign declined to discuss specific policies that may be in the works.
“Guaranteeing health care for every resident has been central to his campaign, and it will be one of his top priorities should he have the honor of serving as governor,” said Nathan Click, Newsom’s campaign spokesman.
California has the economic might to change the conversation on the subject. Yet any substantive move to single payer could jar Democratic candidates in competitive races, who in the current cycle are being advised not to use the phraseand instead rely on terms like “Medicare for all.”
“It’s clear that we’re going to have a debate over the coming years over how to get to universal health care and so right now, we’re at the stage where we’re getting ready and preparing for that,” said Topher Spiro of the Center for American Progress, which earlier this year unveiled a single-payer-like universal coverage proposal that builds on Medicare.
What happens in California, Spiro said, “will be very instructive for the national debate.”
Insurance industry lobbyists and physicians believe that Newsom is likely to moderate his stance. The California Medical Association, which has endorsed Newsom despite its opposition to the state’s single-payer legislation, believe he’s committed to the same goal.
The group’s president, Theodore Mazer, said the candidate sometimes equated single payer with access to health care for every resident: “We see it differently, and feel we can work with him to show there are other pathways to get to universal health care in California that don’t necessarily call for a government-run health system.”
Consumer advocates hope Newsom will take a page from this year’s effort to push forward a package of bills in the Legislature to expand coverage regardless of legal status, increase state-funded financial help and beef up consumer protections. Brown failed to fund those proposals in his 2018-2019 budget, effectively dooming their prospects for the year.
“Getting closer to universal coverage by itself would be a big and bold move,” said Anthony Wright, executive director of Health Access California and a leader behind this year’s push to make gains in health care that would not require federal approval. “We discovered this year how even steps toward universal coverage was unfortunately too big a step this year. Hopefully a future governor would be willing to take these steps.”
But the strongest voice for single payer, the California Nurses Association, says it will hold Newsom to his word to achieve nothing short of that goal.
“Health care is a strong value of his, and he values health care as a human right,” said Bonnie Castillo, executive director of the powerful California Nurses Association, which spearheaded single-payer legislation in the state Legislature and was an early backer of Newsom for governor. “We will be there advocating very strongly for Medicare for all. We’ll play our role. If that includes putting pressure on him or anyone else, we will do that.”