EDITORIAL: The halting steps in California toward Medicare for All and single payer health care [Santa Cruz Sentinel, Calif.]

Oct. 18—Medicare, the federal health insurance program for people over the age of 65, has been held up by many politicians as the ideal framework for universal health coverage with progressive Democrats pushing for a "Medicare for All" program that essentially provides universal health coverage, a concept also advanced by advocates for "single-payer" health care that would be funded by taxes.

Single payer would eliminate insurers and other aspects of private enterprise from medical care and provide everyone the same services, regardless of income. Under single payer, one entity would be responsible for all costs, while Medicare for All refers to a specific federal single-payer plan. Both seek universal health care coverage, ensuring no one is left uninsured.

Sen. Bernie Sanders, I-Vt., Congress's biggest proponent of Medicare for All, held the last congressional hearing on that policy in May 2022 while serving as Senate Budget chairman. But the hearing did not spark any new momentum for legislation that would advance either or both universal coverage systems.

California, however, seems to be taking steps toward a form of universal coverage. Earlier this month, Gov. Gavin Newsom signed SB 770, a law that seems to kick-start the process to secure a statewide single-payer health system. That move was the first by any state toward single payer. Other states have moved toward a "public option" which is a more incremental approach to government-run health care than single payer and allows residents to opt into a government-funded health program or continue with their private coverage.

The issue arose again this year with two measures in the Legislature: SB 770 to create a framework for a universal system, and the other a tax increase on businesses to finance such a system. The tax proposal to help fund single payer came before legislators earlier this year and would have raised about $150 billion annually to offset the loss of employer-provided coverage, paying for about a third of the estimated cost of a single-payer system for nearly 40 million Californians. The remainder would, in theory, come from pooling money already being spent by federal, state and local governments. But the tax measure went nowhere.

SB 770 now directs the secretary of the California Health and Human Services Agency to work with federal partners on a path forward on a unified health financing system under which money flowing into health care from Washington —roughly 50% of the state's total public and private medical expenditures —would be given directly to the state.

According to the wording of SB 770, the legislation would finance a "comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits, which includes primary, preventive and wellness care services."

But it doesn't specify a single-payer system, and some advocates, particularly the nurses' association, are opposing the bill saying Newsom's approval of SB 770 was "a complete betrayal of nurses' fight for a single-payer health care policy."

At most, SB 770 is a somewhat halting step toward universal coverage in a state where Newsom and the Legislature have already expanded Medi-Cal to groups lacking coverage, such as undocumented immigrants. Medi-Cal is California's version of the federal Medicaid program offering no-cost and low-cost health coverage to eligible people who live in California. Those actions, plus the mandates and subsidies of "Obamacare," have led to 94.8% of Californians being covered by some kind of health insurance, according to a recent UCLA survey.

But getting the federal government to send an estimated $200 billion back to the state creates a whole set of other problems, since single payer would require Californians now receiving care through employers, unions or public agencies to give up their benefits and join a universal system administered by the state.

But, considering how the state has administered massive programs such as unemployment insurance, would all Californians be willing to trust their medical needs and coverage to state government? Really?

Next: How to navigate Medicare programs and what to watch out for.

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