When San Jose Democrat Ash Kalra rolled out a proposal in the California State Assembly a couple of years ago to convert California’s largely private health care system to a government-directed single-payer plan that would cover everyone, he had an idea of what he was up against.
“The No. 1 tool that opponents will put out there is fear,” Kalra told Capital & Main in late 2021. “They’ll try to scare people into thinking that we’re taking something away, when in fact we’re trying to make health care available to everyone rather than subsidize a massively profitable health care industry.”
Kalra later withdrew his proposal without the State Assembly taking a vote — but it’s not at all clear that citizens’ fear of a new system was the reason. Rather, the bill was swamped by the same powerful political lobbying forces that line up in opposition each time a single-payer plan is introduced — and are doing so again this year.
The coalition includes medical companies, hospital associations, insurance associations and doctor groups. Collectively, they’re part of a lobbying system that has spent billions nationally to make sure support for a single-payer program does not gain traction anywhere in the United States, much less in a bellwether state like California.
They’re well funded. They’re organized. And their alliance, called Protect California Health Care, wants to preserve a system that enriches them to the tune of billions and billions in profits every year.
In a missive it shared with Capital & Main, Protect California Health Care called single payer “a costly, disruptive proposal” that was also unnecessary. “Thanks to actions in recent years by this Legislature, Governor Newsom and President Biden, California is on the cusp of providing affordable universal health care for all,” the release said. (More of the organization’s opposition can be found here.)
Universal health care, though, is not Medicare for All or single payer. The term “universal” merely implies that all or nearly all Californians have access to care, through either private or public channels. It says nothing about what it costs patients to actually receive care or the quality of that care, nor does it disrupt the current system under which private insurers and providers turn staggering profits, sometimes by restricting patient access or denying claims.
Protect California Health Care comprises some of the most significant health and medical organizations in the state — and beyond. Among them:
- California Medical Association
- California Hospital Association
- America’s Physician Groups, a national organization
- Association of California Life and Health Insurance Companies
- California Chamber of Commerce, or CalChamber.
By gathering as one coalition under Protect California Health Care, the various groups are able to lobby state legislators more efficiently when they collectively agree on an issue — like opposing a plan that provides health care to everyone; eliminates premiums, co-pays and deductibles; and takes insurance companies out of the mix.
They’re already at work undercutting Kalra’s latest single-payer proposal. AB 2200, Guaranteed Health Care for All, was sponsored by the California Nurses Association. It passed a preliminary vote in April and will next be considered by the Assembly Appropriations Committee. (Disclosure: The CNA is a financial supporter of Capital & Main.)
The idea of a single payer or “Medicare for All” type of program has been rolled out in California several times, beginning in 1994. In each case, health industry lobbyists swarmed the halls of the State Capitol to defeat it.
Despite that, single-payer legislation has made advances over the years. One effort, in the 2005-2006 legislative session, got as far as the desk of then-Gov. Arnold Schwarzenegger, who decried it as “socialized medicine” and vetoed it. A 2017 measure advanced out of the State Senate but was shelved by then-State Assembly Speaker Anthony Rendon, a Democrat, who called it “woefully incomplete.”
Single payer has been popular among California voters. According to polling by the left-leaning Lake Research Partners, likely voters in 2021 favored a Medicare for All health system by a whopping 26-point margin, with 60% for the idea and 34% against.
But voters don’t work the halls of power. Lobbyists do. And the health industry lobby remains vitally invested in killing single payer.
Asking legislators to maintain the status quo often works in politics, but the health industry takes no chances. The California Hospital Association spent $3.5 million on lobbying last year, and CalChamber, which labeled Kalra’s previous single-payer bill a job killer and opposes the current measure as well, spent $3.4 million (not all of it on health care, obviously). Both were among the top 10 groups in lobbyist spending in the state.
The state activity mimics national behavior for the health industry. Health and pharmaceutical companies spent more than $745 million lobbying federal lawmakers last year, making them the No. 1 spender among special interest groups that together racked up $4.2 billion in lobbying costs, according to a report by Open Secrets.
Almost from the moment Harry Truman began trying to create a national health insurance system in the post-World War II years, medical lobbies have fought it at every turn. This is not new ground. While the players may change, the game remains the same.
And while single payer’s cost, its organizational structure and its funding mechanisms are all rightfully the subject of lively debate, none of them individually is the reason the health industry opposes the idea. Rather, single payer represents an existential threat to one of the most profitable industries in U.S. history.
In California in 2020, the most recent year for which the California Health Care Foundation has data, health spending in the state totaled $405 billion. The groups who get a cut of that money are more than willing to spend some of it lobbying for the right to retain the rest. That is what Ash Kalra is up against.
