Single-payer got close so the Democrats killed it

July 4, 2017

Emma Wilde Botta looks at California Democrats' excuses for why they killed their own single-payer health care bill--and argues for the fight to move outside the legislature.

AS REPUBLICANS in Washington, D.C., pursued the latest disastrous variations on Trumpcare, California Democrats were busy squashing the Healthy California Act (SB 562), a bill that would have begun the work to establish a single-payer system in the state.

On June 23, Assembly Speaker Anthony Rendon announced, "SB 562 will remain in the Assembly Rules Committee until further notice"--supposedly in order to make fighting Trumpcare "the top health care priority."

Rendon's decision, lauded by other powerful Democrats including Governor Jerry Brown, denied a vote on the legislation in the State Assembly after it passed the state Senate 23-14 last month.

The passage of SB 562 would have posed an ideological challenge to decades of neoliberal privatization and galvanized the single-payer movement at a time when deep cuts to Medicaid are on the agenda in Washington. Single-payer advocates should consider the trajectory of SB 562 and draw lessons about future efforts to win health care for all.

THE OPPOSITION to SB 562 focused on supposedly intractable financial issues. A widely cited Senate committee report estimated the bill would cost $400 billion annually. The eight-page report acknowledged that an existing $200 billion in funds from federal, state and local sources could offset part of the program's cost, and proposed a 15 percent payroll tax to raise additional funds.

California nurses take to the streets to demand universal health care
California nurses take to the streets to demand universal health care (California Nurses Association | Facebook)

"This was essentially a $400-billion proposal without a funding source," Rendon said in an interview last week with the Los Angeles Times. "That's absolutely unprecedented...This was not a bill, this was a statement of principles."

Rendon is correct that specific tax proposals weren't included in SB 562--but it's not at all the case that the legislation lacked possible funding mechanisms.

Researchers at the University of Massachusetts Amherst looked at the fiscal impact of single-payer in California and proposed a way to fund the program. Their study estimated that the legislation would reduce overall health care spending by about 8 percent compared to the existing system--with massive cost savings for individuals and small businesses--even as it expanded coverage for the estimated 3 million uninsured.

About 70 percent of California's health care spending is currently paid through public programs. The researchers found that two new taxes--a 2.3 percent gross receipts tax and a 2.3 percent increase in state sales tax--would be able to replace private insurance funds.

So while SB 562 may not include specific funding, there is no doubt that single-payer can be funded in California--and save state residents money to boot.

IF THE Democrats wanted to implement single-payer in California, they could have done so. With a 55-25 majority in the Assembly, they were in a position to pass SB 562 and raise the taxes needed to pay for it.

Legislators who were truly committed to health care for all would have spent the summer hammering out the details. But the effort to pass SB 562 in the Assembly would have demanded Rendon and others present the convincing fiscal argument for single-payer and take a stand for health care as a right. They were unwilling to do so.

While single-payer advocates are understandably directing anger at Rendon, the bill's authors Ricardo Lara and Toni Atkins are at fault as well.

The state senators' omission of specific tax proposals in SB 562 ensured an easy argument against the bill, and they failed to publicly address the tricky legislative hurdles that SB 562 faced--in particular, Proposition 98, passed in 1988, which requires about 40 percent of the state's budget go to K-12 education.

Though eager to win acclaim as supporters of single-payer, Lara and Atkins appear to have lacked the political will to present a serious plan to actually make it happen and transform California's health care system.

The fight for SB 562 has shown how "progressive" and "establishment" Democrats complement one another. The progressives rack up points--both for themselves and the party--from voters who overwhelmingly support single-payer, while the establishment ensures that the interests of the party's big money donors are ultimately protected.

As Nancy Pelosi recently reminded us, the Democratic Party is a capitalist party--and one with deep connections to the private health insurance industry. According to OpenSecrets, during the 2016 election, Blue Cross/Blue Shield donated $3.8 million to the Democrats and $2.8 million to the Republicans.

The implementation of single-payer in the country's largest state would pose a real threat to the many industries that profiteer off people's health care needs. The current health care system may not be working for most of us, but it's pretty great for the companies that make billions in profit and the CEOs who take home millions in salary and bonuses each year.

Democratic politicians must tread carefully around single-payer in order to avoid alienating a base that overwhelming supports health care for all--but they are far too invested in the well-being of the business class to want to disrupt the existing setup.

THE REPUBLICAN'S detestable excuse for a health care bill shouldn't make us ignore the growing problems of the Affordable Care Act passed under the Obama administration--including rising premiums, states refusing to expand Medicaid, and insurance companies pulling out of the exchanges altogether.

The increasing frustration with profit-based health care is leading more and more people to join in the chorus for single-payer.

Bernie Sanders presented single-payer as a viable alternative to the current system during his presidential campaign, and Sen. Elizabeth Warren has recently suggested that her party adopt single-payer as part of its official platform.

Just as in California, however, party leaders like Pelosi continue to flatly reject the idea, even as a recent Pew Research Center poll shows 60 percent of people agree that it is the federal government's responsibility to make sure all Americans have health care coverage.

Furthermore, one in three people favor a single health insurance system run by the government, up five percentage points since January and 12 points since 2014.

The moment is ripe for a successful single-payer movement. But what strategy will we pursue next year?

It is incumbent on activists to propose feasible pathways to single-payer. This type of health care reform clearly faces an uphill battle within the halls of the legislature, so we need to bring the issue to the public, both in demonstrations and ballot propositions.

Political hurdles like Proposition 98 must be acknowledged and discussed openly by single-payer advocates. We also know it will take millions of dollars to overcome the opposition's predictable campaign of misinformation. Additionally, any fight for single-payer in one state must be accompanied by a commitment to single-payer nationally.

We can't rely on Democratic politicians to chart the course for us. In the next weeks and months, we must collectively decide how to move forward with single-payer in California. There may be disagreements, but if we are willing to learn from the experience of SB 562, we'll be better positioned to finally win the dream of making health care for all a reality.

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