The initial quasi-debate last week among the four declared Democratic candidates for governor strongly indicated that access to medical care may be a dominant campaign issue.
However, it also strongly indicated that voters will likely see more sloganeering on the issue than reality-based prescriptions.
That would be unfortunate, because it’s an issue that potentially affects not only the well-being of 39 million Californians but the state’s largest single economic activity.
An exhaustive study by UCLA’s Center for Health Policy Research, released last year, found that health care is now a $367 billion per year California industry, with 71 percent paid by local, state and federal governments and the remainder by employers and/or individual consumers.
The feds are picking up half of the state’s medical bills, primarily through Medi-Cal, which now covers 14 million low-income Californians, Medicare for the over-65 set and benefits to military and civil service retirees.
Although Medi-Cal underwent a major expansion through the Affordable Care Act, known popularly as Obamacare, it’s estimated that about 3 million Californians, most of them undocumented immigrants, still lack coverage and depend on private and public charity for care.
Covering them would add about $33 billion to the annual cost, bringing it to an estimated $400 billion – more than twice the state budget and the core of the debate.
All four candidates endorsed expansion of coverage, but they also used two terms – “single-payer coverage” and “universal coverage” – that aren’t necessarily synonymous.
The former means that one new state agency would control the system, as proposed in Senate Bill 562, which cleared the state Senate this year only to be stalled in the Assembly by Speaker Anthony Rendon. He refused to consider anything that lacked financing and took heavy fire from advocates in the left wing of his party.
The alternative term, “universal coverage,” implies that we could leave the present system, a combination of public and private programs, in place and simply add enough money for those now lacking coverage.
The leading Democratic candidate, Lt. Gov. Gavin Newsom, endorsed the single-payer approach, saying – erroneously – “the money exists in the system.” But the man now polling second, former Los Angeles Mayor Antonio Villaraigosa, backed Rendon’s position, referring to promises without financing as “snake oil” and adding, “The fact of the matter is we don’t have a plan yet.”
Rendon and Villaraigosa are correct about SB 562’s many shortcomings. It assumes that the feds would be willing to lump all of the health care money it’s now spending in California, nearly $200 billion a year, and give it to a new state entity. State and local governments assumedly would do the same but, according to a legislative analysis of the measure, even if they did, it would still require $200 billion “in additional tax revenues to pay for the remainder.”
That’s no small amount. The analysis says it would equate to a 15 percent additional tax on all “earned income,” although the bite would be offset in some measure by eliminating costs now borne by employers and consumers.
Furthermore, getting the feds to cooperate would be immensely difficult, and not only because Republicans now control Washington. Government employees and retirees probably would not be willing to merge their benefits into a state-run program.
If the basic, although unstated, goal of advocates is to cover undocumented immigrants and California really wants that, there’s no need to mask it in a dicey, probably unworkable, “single-payer” system. They could clearly say what they want, propose the taxes to do it and let the chips fall where they may.