California Should Wake Up From Its Single-Payer Dreams

Single-payer health care has new life in California. State lawmakers just introduced AB1400, legislation that would launch a government takeover of the state’s health insurance system, effectively banning private coverage and enrolling every Californian in the same plan.

One of the bill’s co-authors, Assemblymember Miguel Santiago, says that putting the state in charge of Californians’ care will deliver a “health care model that is affordable and accessible to all.” Assembly Member Ash Kalra agrees, saying that single-payer would “save lives” and “improve public health.”

Hardly. Not only would single-payer vacuum up unprecedented amounts of money from California’s taxpayers — it would actually reduce access to care.

Four years ago, California’s leaders recognized as much. In 2017, Assembly Speaker Anthony Rendon killed the Healthy California Act, a carbon copy of the bill offered by Santiago and Kalra. The act had passed the state Senate, but Rendon called it “woefully incomplete” with “potentially fatal flaws.”

And those were understatements. One analysis found that single-payer would’ve cost California $400 billion — more than double the state’s annual budget. The legislation’s champions then offered no plan for covering that cost.

The same is true this time around. According to reporting from Kaiser Health News, California Democrats have “not identified a way to pay for the massive transformation” and are “unsure whether it would require higher taxes.”

Spoiler alert — it would. Common sense would dictate that more than doubling the state budget would require new tax revenue. When the Senate Committee on Appropriations actually did the math on 2017’s Healthy California Act, they verified that conclusion. They assumed that the state would have to impose a new 15% payroll tax to raise the requisite funds.

Tax hikes would’ve been poorly received four years ago. But amid the pandemic-induced economic downturn, they’re an impossibility now. The Golden State lost 1.5 million jobs between February and December of 2020. Preliminary data from the Little Hoover Commission suggest that our current crisis will have a more substantial impact than any of California’s past three economic downturns, including the Great Recession.

In exchange for all those new taxes, Californians would get the privilege of waiting for care.

Consider what happens in Canada’s single-payer system. Canadians wait a median of over 22 weeks for treatment from a specialist following referral by a general practitioner and a specialist.

Those delays have long-term, devastating consequences. One report from the Vancouver-based Fraser Institute concluded that delays for care may have cost more than 63,000 Canadian women their lives between 1994 and 2009.

These aren’t just horror stories from far-off lands. A new report from the U.S. Congressional Budget Office suggests that patients here could suffer a similar fate. In an analysis of five hypothetical single-payer proposals, the CBO concluded that demand for care would outstrip supply — and that long waits would be the result.

Single-payer advocates in Sacramento — including Gov. Gavin Newsom — have ignored the mountains of evidence against their desired overhaul of the state’s health care system.

Perhaps that’s because one of their own could soon be in a position to grease the wheels for their grand health care experiment. California Attorney General Xavier Becerra, President Biden’s new secretary of the Department of Health and Human Services, has supported single-payer health care for decades. He has the authority to grant California a waiver to implement statewide single-payer.

For the sake of California’s health and economic well-being, let’s hope we don’t get anywhere near that point. A government takeover of our health care system is at best fiscally irresponsible — and at worst hazardous to patients’ health.


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