Gov. Gavin Newsom made guaranteed health care a central piece of his gubernatorial campaign some four years ago, promising specifically to deliver a single-payer system that would give every resident free access to comprehensive treatment.
In an April 2018 interview with the San Francisco Chronicle, however, Newsom did what he's done on numerous issues throughout his tenure as governor: He muddied his position by telling the newspaper's editorial board that "it is not an act that would occur by the signature of the next governor. There's a lot of mythology about that."
Heartened by this obfuscation, Blue Shield of California and several health care industry super PACs made six-figure donations to his campaign — relationships that blossomed into tens of millions of dollars of so-called behested payments on Newsom's behalf during the pandemic. He rewarded the industry's kindness with massive no-bid government contracts that resulted in botched testing services and underutilized vaccination programs.
It's unclear which version of the governor will emerge on the vital issue of guaranteed health care this year. One piece of a legislative package to create a single-payer system called CalCare, funded by a mix of tax increases, could reach the state Assembly floor by the end of the month. While many hope public pressure will compel Newsom to revive his promise, his actions as governor inspire skepticism.
Still, California's top elected official can help foster the statewide discussion he owes to 40 million residents enduring a once-in-a-lifetime pandemic along with the depredations of a profit-driven private health care sector. With the Newsom administration's support for further consideration of Assembly Bill 1400 and an Assembly vote to keep it alive, lawmakers and the public could begin an honest debate that is as critical as ever for the health and well-being of every California resident.
An estimated 3.2 million people in California lack health insurance. Many more face the crushing rigors of a private system that over-complicates essential medical care and excessively charges patients for lifesaving procedures and prescriptions. Business is generally good for America's $4.1 trillion health care industry, which grew more than 9% in 2020 and accounts for roughly one-fifth of the nation's economy.
The benefits of a single-payer system — such as eliminating excessive copays, deductibles and prescription costs — are clear. The idea is also popular, supported by more than 6 in 10 Americans, according to the nonpartisan Pew Research Center. Single-payer opponents push a false narrative that caters to business interests over people who need care.
In 2017, the state Senate Appropriations Committee estimated that operating a single-payer system would cost $400 billion annually, requiring an additional $200 billion in new taxes to cover the cost. While the prospect of new taxes can be unsettling, California residents already spend $367 billion on health care each year, with taxpayers footing 70% of that, according to the UCLA Center for Health Policy Research. Replacing employer-provided insurance may not be as dramatic a shift to our paychecks or tax filings as some suggest.
This month, Newsom proposed a much cheaper Medi-Cal extension that would provide care access to undocumented immigrants and — with the help of political semantics — allow California to claim universal health care. It is a necessary and long-overdue measure to protect vulnerable communities that fill critical parts of California's workforce, which has experienced higher death rates and lower vaccination rates throughout the pandemic due partly to exclusion from the health care system.
California's Democratic supermajority will likely pass that proposal with ease. The real act of political courage would be supporting AB 1400, which enjoys much more legislative backing than previous proposals. Its supporters include Assembly Speaker Anthony Rendon, who let the last single-payer proposal die in 2017.
Perhaps Newsom could take his own advice from that year. As he tweeted, "I'm tired of politicians saying they support single payer but that it's too soon, too expensive or someone else's problem."
