A radical idea revived: Single-payer health care bill introduced

As lawmakers in Washington move to repeal the Affordable Care Act, a state lawmaker is reviving a radical idea: transform California's private health insurance system into a state-run single-payer model. 

State Sen. Ricardo Lara (D-Long Beach) has introduced the Californians for a Healthy California Act, which proposes "a comprehensive universal single-payer health care coverage program." Under this approach, private health insurance would be replaced with a single state-run program. Lara said his plan would guarantee coverage to all Californians and would bring down the cost of health care.

"Given the uncertainty of what’s happening at the federal level with President Trump hell-bent on the demise of the Affordable Care Act, it’s up to California to come up with a better plan for how we deliver health care to millions of Californians," he said.

It’s far from the first time this kind of system has been proposed in California. In 1994, voters rejected a ballot measure that would have established a single-payer system. The legislature passed single-payer bills in 2006 and again in 2008, only to have Gov. Arnold Schwarzenegger veto the measures.

The United States is the only major western industrial nation that does not provide universal health coverage. In 2011, Vermont became the first U.S. state to agree to establish a single-payer program, but the effort fizzled three years later over concerns about the cost. 

At the moment, Lara's bill only says it is the "intent of the legislature" to establish a single-payer system. It does not say exactly how the program would work or how much it would cost. Lara says those details will come later.

Any push for a single-payer system can expect fierce opposition from much of the medical establishment.

"The fundamental question is, who's going to pay for it?" said Charles Bacchi, president of the California Association of Health Plans. The Association criticized previous single-payer proposals as requiring tax increases, and Bacchi said a single-payer plan would not address the rising cost of health care.

"Whether you're paying with premiums or you're paying for it with taxpayer dollars in a single- payer system, we come back to the fundamental issue, which is that health care costs continue to go up," he said. A single-payer system might not necessarily get a better deal from providers, said Bacchi, because "you have to have a provider community that is willing to agree to take less." 

A spokeswoman for Gov.Jerry Brown said that his office generally doesn't comment on pending legislation.

The California Nurses Association is the bill's primary sponsor.  Associate Executive Director Bonnie Castillo said she doesn't think "any legislator or anyone in the administration can categorically rule this out without engaging and listening." 

California is "uniquely situated" to pass a single-payer plan right now, she said, "given that we have a Democratically-controlled legislature and all of the state offices are occupied by Democrats who have a core belief of health care as a human right."

Lara's bill comes as local and state officials are discussing how to deal with the possible loss of billions of federal health care dollars. The Los Angeles County Board of Supervisors moved on Tuesday to take a leading role in that effort, passing a motion that directs county staff to "develop options of how health insurance coverage could be maintained and/or extended" within the county and the state in case Congress repeals the Affordable Care Act.