It goes by various names: universal health care access; national health care; Medicare for all; government-run health care; even socialized medicine. Most news reports call it “single payer.” It threatens to tear asunder California’s Democratic Party.
Single payer, in which the government ultimately covers the cost of health care, has become the bright line of demarcation between the more liberal Berniecrats and more moderate Establishment Democrats. Among party activists, it is an emerging litmus test for party purity.
“If single-payer healthcare is going to mean complete takeover by the government of all healthcare, I’m not there yet.” — Dianne Feinstein.
Opposition is fierce. The influential California Medical Association said in January that single-payer legislation in the Capitol, SB 562, “would eliminate Medi-Cal, Medicare, all private insurance and the Covered California exchange for a singular health care insurance product provided by the state, without offering any way to pay for it.”
The danger to Democrats is that disagreement over the issue could depress their turnout, with some more left-leaning Democratic activists refusing to support fellow Democrats who are not sufficiently enthusiastic about single payer.
The Democratic disparity is wide and public.
“If single-payer healthcare is going to mean complete takeover by the government of all health care, I’m not there yet,” Democratic Sen. Dianne Feinstein said at a town hall in April of 2017.
But three months later, her fellow Democrat, Sen. Kamala Harris, said she intended to co-sponsor Sen. Bernie Sanders’s Medicare for All bill “because it’s just the right thing to do.”
Feinstein’s likely opponent as she seeks a fifth term this November is Kevin de Leon, another Democrat and until recently the leader of the California Senate. He’s all for single payer. So is his successor as Senate leader, Toni Atkins.
De Leon in February received an endorsement from the California Nurses Association, the chief sponsor of Single Payer in California, and declared:
“… I voted to pass single payer legislation because our representatives in Washington, D.C. have wavered on this issue for far too long,”
“We’re talking about a sea change – it’s absolutely breathtaking. Nothing in our lifetime is as significant as single payer.”– Dr. William Bronston
But on the other side of the Capitol, Democratic Assembly Speaker Anthony Rendon shelved SB 562, the Senate-passed single-payer bill that Atkins supported. Rendon says he’s for Single Payer as a concept, but SB 562 lacked any details on financing.
That move outraged longtime single-payer supporters, such as retired Dr. William Brownston, who heads the Sacramento chapter of Physicians for a National Health Program.
Bronston contends single payer is more than merely a good idea — it’s a society-transforming phenomenon.
“We’re talking about a sea change – it’s absolutely breathtaking,” he told Capitol Weekly in a telephone interview. “Nothing in our lifetime is as significant as single payer.”
Foes of single payer are led by vested interests who want to preserve their financial advantages, he said.
Antonio Villaraigosa believes single payer, as advocated by rival Gavin Newsom, would force seniors off Medicare.
“The insurance industry makes no contribution to health care. We’ve been flooded with corporate propaganda against single payer,” he says, arguing that significant campaign contributions from the insurance and medical industries are the reason Gov. Brown and Assembly Speaker Rendon have not been more enthusiastic about single payer.
“There has to be enough of a grass-roots uprising to force the corrupt Democratic Establishment to accept single payer,” he says.
Single payer has already become one of the major issues in the race to become California’s next governor.
Lt. Gov. Gavin Newsom, the Democrat leading the race for governor, is unabashedly in favor of single payer. But fellow Democrat Antonio Villaraigosa, running against him, says he favors the concept of single payer, but not SB 562.
Villaraigosa says single payer, as advocated by Newsom, would force seniors off Medicare; the California Nurses Association, backing Newsom and Single Payer, called Villaraigosa’s accusation “fear mongering” and “disgracefully intended to alarm seniors about their Medicare coverage.”
In another sign of the party’s shift to the left, delegates to the February 2018 convention in San Diego refused to endorse Feinstein for re-election.
California’s most famous Democrat, Jerry Brown, voiced a similar concern in March of 2017. “Where do you get the extra money? This is the whole question,” the governor said in a Washington exchange with reporters.
Thirty-six years ago, however, Brown wasn’t so doubtful about Single Payer.
“My preference is that we create a single system, put everyone under a universal health care system. We treat health care not as a commodity to be played with for profit but rather the right of every American citizen when they’re born,” he said in April 1992 in a debate with Bill Clinton when both were seeking the Democratic presidential nomination.
The California Democratic Party’s platform is forthright on single payer:
“California Democrats believe that health care is a human right not a privilege. The CDP recognizes that the health and well-being of Californians cannot continue to be based on arbitrary private and public financial decisions and therefore advocates legislation to create and implement a publicly-funded single-payer, privately delivered, fiscally tractable, affordable, comprehensive, secure, high quality, efficient, and sustainable health care system for all Californians.”
In another sign of the party’s shift to the left, delegates to the February 2018 convention in San Diego refused to endorse Feinstein for re-election. They didn’t endorse de Leon either, but the non-endorsement of an incumbent Democratic senator was a major slap in the face to Feinstein. She had 37 percent of delegate votes and de Leon had 54 percent, just short of the 60 percent needed for endorsement.
In June of 2017, The Pew Research Center reported a jump in Democratic approval of single payer.
But will a civil war between two camps of Democrats really affect how voters behave this June and then in November?
It may be firing up party activists, and may affect how hard they push voters, but among the larger electorate so far, the intra-party squabbleseems to awash in contradictions. A Public Policy Institute of California poll in February had Single Payer doubter Feinstein leading Single-Payer enthusiast de Leon 46 percent to 17 percent, with 33 percent of likelyvoters undecided.
In June of 2017, The Pew Research Center reported a jump in Democratic approval of single payer:
“Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.”
“It will cost $400 billion. Wrong. Over 90 percent of that is what we already spend on healthcare.” — Deborah Burger
The 43,000-member CMA worries about the cost. In its Jan. 17 statement, it said: “What’s more, the Legislative Analyst’s Office (LAO) found that the proposal could ‘require new state tax revenues in the low hundreds of billions of dollars and ‘could result in a lower minimum funding requirement for schools and community colleges’ under Proposition 98. In other words, SB 562 would pit health care groups against public education advocates in an annual battle for state budget dollars…”
In a Jan. 24 op-ed in the San Diego Union-Tribune, Deborah Burger, co-president of the California Nurses Association, challenged such cost assumptions:
“It will cost $400 billion. Wrong. Over 90 percent of that is what we already spend on healthcare,” she wrote.
“Savings from a single-payer system on funds insurers siphon off for profits, paperwork for denials of care insurers don’t want to pay for, and lucrative executive pay packages, and the state’s ability to use its bulk purchasing power to lower drug costs, will further reduce the overall spending. No other proposed approach to ‘cost containment starts with $37.5 billion in savings, as Senate Bill 562 does, and then constrains prices and costs in the most effective ways.”
With battle lines already drawn, the intraparty battle is probably going to become more heated in coming months, likely forcing Democratic candidates who have so far avoided the issue to take a stand for or against – either losing or gaining votes.