Health Care - Not a Litmus Test, Not a Wedge Issue

In Washington D.C., Republicans in Congress are dismantling the Affordable Care Act (ACA), potentially erasing health care for millions in the pursuit of conservative ideology.

Here at home, the California State Senate has just approved SB-562, a Utopian single-payer bill that would erase the ACA even more thoroughly than the GOP’s plan, while offering virtually unlimited medical care to anyone who shows up in our fair state with the intent to reside.

The contrast gives you whiplash. Good luck getting that treated under either plan.

Universal health coverage is a worthy goal, especially in contrast to Mitch McConnell’s Dickensian vision. (Are there no workhouses?) But the details of California Senate Bill 562 call into question its viability and purpose. Analysts say the bill would more than double the state’s entire budget, and proponents are wielding the bill as a wedge issue they openly hope will divide state Democrats into warring factions.

Please, someone, can we get a health care plan that isn’t a political manifesto? 

SB 562 is a single-payer plan, and for many that is reason enough to support it. But here are some notable elements of the plan, drawn from the bill’s 21 pages and an 8-page financial analysis prepared by Senate Appropriations staff:

SB 562 would create a spanking-new $400 billion (yes, all references are in billions) state agency dubbed Healthy California (HC), created and run by an unpaid nine-member board with seats doled out by various state officials.

For comparison purposes, California’s General Fund budget for 2017-18 is $128 billion, paying for K-12 and higher education, health and human services, corrections, etc. Toss in $55 billion in special revenue funds, including federal funding and gas-tax income, and you get roughly $183 billion in annual funding this year, overseen by an elected governor and state legislature.

Keep in mind that $400 billion for HC is a very rough estimate, because it assumes that the federal government will continue current levels of Medicare and Medicaid spending, and let the state use it for single-payer.

In addition, the plan’s generous coverage lacks basic tools for cost controls, such as co-pays, deductibles, drug formularies or prior authorization for seeing a specialist.

Payment would be fee-for-service, more costly than managed care. Members could choose any provider to be their ‘care coordinator’ – whether a family physician, podiatrist or a high-priced specialist.  The plan would cover any services a care coordinator thinks is medically necessary – regardless of industry best practices.

Benefits would include eyeglasses, hearing aids, skilled nursing care, home health care, nursing home health care, mental health care, dental care, prescription drugs, adult day care, podiatric care, chiropractic care, acupuncture, and much, much more. Private insurers would be banned from covering any service offered by Healthy California.

All state residents would be covered, regardless of citizenship. Health immigrants could come from abroad, as well as from U.S. states without free, universal health care. Which is to say, all 49 of them.

The costs, whatever they are, would be largely borne by wage-earners and businesses. The argument that existing health-care costs will simply be spent more virtuously by a single-payer system, without vast new expenses, does not add up.

The odds of this plan surviving the Governor’s veto, and being approved by voters, are vanishingly slim. So why are we wasting our time?
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A real discussion of California’s health care future should include public discussion of alternatives – improving the ACA, offering a public option for people to buy into Medicare, going full Kaiser-Permanente, and of course single-payer. 

Editor's note - since this story was written, the bill was tabled by the California State Assembly. However, because this is the first year of a two-year session, SB562 could be revived next year.