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06/15/2017

Single-Payer in California?

I’m not sure that even advocates of single-payer health care will find the spectacularly overreaching “Healthy California Act” (California Senate Bill 562) a good idea.  Follow the link and read the text yourself—I link, you decide.

While the bill appears at points to read like a re-assertion of current federal programs, and perhaps some related private insurance (e.g., Medicare Advantage), in fact it looks to me like it would replace all current public and private health insurance for California residents, whether citizens or not, with a state run, state financed (how is yet to be determined) single plan called “Healthy California.”  This is how it is described in the general press.

Under it, no California resident would have to pay a dime for any aspect of health care.

As I read it, no other insurance plans would be allowed to pay for anything that Healthy California covers.  Just about anything and everything health-care related—including, it appears, skilled nursing and long-term care—would be “covered.”  Of course, any extra billings outside the coverage would be illegal.  Practitioners could opt out of the program but that means they couldn’t get paid—except, I suppose, on some sort of black market. 

Healthy California would be run by an independent 9-person board with no clear accountability.  This board would set coverage range and payment rates; certify doctors, hospitals, and other providers (including out of state, in case a Californian gets sick while traveling); oversee the collection and management of not only claims payments but also health and health-payment statistics, and do just about everything else that Medicare or your (evil?) insurance company currently does.  It would be advised by a separate 22-person advisory panel.

The legislation calls for any and all federal payments that otherwise would come into California for health care to be made to Healthy California.  It is argued that additional monies would be needed to pay for everything.  The bill says only that the legislature will come up with a plan for funding, and that the program would not go live until the funding is in place.  News reports have estimated the costs at up to twice the current total California state budget.  Estimates for how it would be paid for include things like a 15% payroll tax on everyone, and other measures.

I can accept that access to medical care should be a duty of human society.  I don’t think that means first-dollar coverage for everything, for all.  I also fail to see why reforms can’t be made within the overall structures of a market economy.  I read that Britain is having trouble with its National Health Service, and that people there try to “go private.”  And I don’t know whether anything will come out of the current Congress, or what it will look like.  I AM fairly sure that without substantial reform of Medicare and Medicaid, the money for them will start running out in my likely lifetime.  I don’t think the Affordable Care Act put us on a stable path.

But I also must say that I have wearied of trying to figure it all out, and I think the nation is on something of a ratcheting path toward national single-payer.  So we will carry out the experiment, as it were, perhaps before long.  (Then we’ll all “have coverage.”  I hope we will all be able to get in to see a doctor.) 

While we wait for that, the “Healthy California Act” looks to me like childish fantasy.  Any readers of this blog who read the bill and can explain how it will be workable are invited to do so in the comments section.

For my part, my wife is on Medicare, which is working reasonably well for her, and I like my current employer-sponsored insurance.  I would like the choice to stay with those, not have them replaced by fiat by the single-party California government.

The California bill passed the state Senate, and awaits action in the Assembly.  If it passes there, my guess is the current governor will veto it.  The likely next governor probably will not.

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