Sin­gle-payer bill is all talk, no sub­stance

Los Angeles Times - - CALIFORNIA - GE­ORGE SKEL­TON in sacra­mento

Don’t de­lude your­self that leg­is­la­tion to cre­ate a Cal­i­for­nia uni­ver­sal health­care sys­tem passed the state Se­nate last week. All that passed was au­tho­riza­tion to keep yakking about it in dream­land.

Or you can look at it this way: A fan­tasy-driven sin­gle-payer health­care con­cept was given the equiv­a­lent of a grade-school so­cial pro­mo­tion. It should have been held back for a lot more work but was ad­vanced un­de­servedly to the next level.

The goal of the bill, SB 562, is to estab­lish a state-run health­care sys­tem that cov­ers all 40 mil­lion Cal­i­for­ni­ans, in­clud­ing roughly 2 mil­lion who mi­grated here il­le­gally.

There re­ally aren’t any de­tails, but as en­vi­sioned, it would re­place all pri­vate and gov­ern­ment in­surance, in­clud­ing se­nior cit­i­zens’ Medi­care. Right there, the bill’s ad­vo­cates should stop. Fed­eral Medi­care works fine. Leave it alone.

The Cal­i­for­nia con­cept is pro­moted as “Medi­care for all,” ex­cept it wouldn’t be Medi­care. And it wouldn’t in­clude Medi­care’s abil­ity to buy ex­tra service through a pri­vate plan.

No one can be sure of any­thing, how­ever, be­cause this is a hol­low bill — a bill in name only.

The leg­isla­tive au­thors, Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), promised to keep try­ing to mold a real bill.

No one even knows the bill’s price tag. But what­ever it is, it’s as­tro­nom­i­cal.

An analysis by the Se­nate Ap­pro­pri­a­tions Com­mit­tee, chaired by Lara,

pegged it at $400 bil­lion an­nu­ally. To put that in per­spec­tive, to­tal state spend­ing for the next fis­cal year is pro­jected to be $290 bil­lion, in­clud­ing $107 bil­lion in fed­eral dol­lars.

Lara says Cal­i­for­ni­ans cur­rently spend $367 bil­lion each year on health­care — fed­eral, state and pri­vate money. His bill would use that money, elim­i­nat­ing pri­vate in­surance. There’d be no pa­tient co-pays or de­ductibles.

The Cal­i­for­nia Nurses Assn., the bill’s loud­est ad­vo­cate, paid for a Univer­sity of Mas­sachusetts Amherst study that picked a $331-bil­lion cost. Lara is run­ning for state in­surance com­mis­sioner with the nurses’ back­ing.

Even if the state gob­bled up all the gov­ern­ment and pri­vate money be­ing spent on health­care in Cal­i­for­nia, there’d still be a need for a state tax in­crease of up to $100 bil­lion. A 15% pay­roll tax is en­vi­sioned. The nurses also sug­gested busi­ness and sales tax hikes. Lots of luck with that.

The ra­tio­nale for pass­ing a shal­low bill de­void of sub­stance was that June 2 was the dead­line for a mea­sure to be ap­proved by its orig­i­nal house.

“The way the rules work in the Leg­is­la­ture, we are dead­line-driven,” Sen. Bob Hertzberg (D-Van Nuys) ar­gued dur­ing the long floor de­bate. The bill cer­tainly has “many holes,” he said, but it should be kept alive and moved to the Assem­bly for ne­go­ti­a­tion and fine­tun­ing.

Ex­cept, the dead­line ar­gu­ment was a poor ex­cuse for the Se­nate not do­ing its job. Most leg­isla­tive dead­lines, like this one, are of the Leg­is­la­ture’s own mak­ing. And the dead­line can be sus­pended on a two-thirds vote — the same vote that would be re­quired to pass a sub­stan­tive bill with a fund­ing plan.

There would be a hard dead­line Jan. 31 for Se­nate pas­sage. But even af­ter that, the bill’s sub­stance could be amended into leg­is­la­tion with a dif­fer­ent bill num­ber — a com­mon “gut and amend” tac­tic.

So what the Se­nate did was dis­ap­point­ing and rather shame­ful if you’re a sin­gle-payer ad­vo­cate. Rather than dig­ging in and de­vel­op­ing an ac­tual plan, it passed the chore over to the Assem­bly, which hasn’t shown much in­ter­est in the sub­ject.

“This is the most dif­fi­cult is­sue I’ve ever agreed to work on,” Atkins told the Se­nate. “Let me as­sure you I’m se­ri­ous about it. This is the big­gest is­sue the state of Cal­i­for­nia has un­der­taken in a very long time.”

Then you’d think it would have war­ranted more time and en­ergy. But, re­al­is­ti­cally, it’s prob­a­bly an im­pos­si­ble task given the com­plex­ity, com­pet­ing in­ter­ests and pol­i­tics.

The bill passed on largely a party-line vote, 23 to 14, with most Democrats for it and all Repub­li­cans against. Be­cause it didn’t in­clude any fund­ing, only a sim­ple ma­jor­ity vote was re­quired.

Give four Democrats credit for re­fus­ing to sup­port it: Sens. Steve Glazer of Orinda, Ben Hueso of San Diego, Richard Roth of River­side and Richard Pan of Sacra­mento. Glazer voted “no.” The oth­ers ab­stained.

“We should keep it here and fin­ish the work,” Glazer said, “then put it on the bal­lot in 2018.”

“This is the Se­nate kick­ing the can down the road to the Assem­bly and ask­ing the Assem­bly to fill in all of the blanks,” Hueso said. “I don’t see this bill com­ing back from the Assem­bly. I think this bill will die in the Assem­bly.”

Repub­li­cans brought up some prac­ti­cal prob­lems for the bill. Start with the fact that Cal­i­for­nia is only a state, not a na­tion. It would be al­most im­pos­si­ble for one state to en­act a sin­gle­payer sys­tem by it­self.

And Cal­i­for­nia’s antiTrump Demo­cratic leg­is­la­tors would need the Re­pub­li­can pres­i­dent to gen­er­ously turn over fed­eral Med­i­caid and Medi­care funds to make their sin­gle­payer dream come alive.

“We give Trump crap day in and day out, and we’re go­ing to beg him for a cou­ple hun­dred bil­lion dol­lars?” Sen. Tom Ber­ry­hill (RModesto) asked.

Any­way, even if the Leg­is­la­ture did man­age to pass a bill, Gov. Jerry Brown prob­a­bly would veto it. He’s very skep­ti­cal about the fi­nanc­ing.

We’ll be watching what the Assem­bly pro­duces. Maybe they’ll sur­prise us. But prob­a­bly there’ll just be more yak.

Rich Pe­dron­celli Associated Press

SUP­PORT­ERS OF sin­gle-payer health­care march for SB 562 in Sacra­mento. The state Se­nate passed the leg­is­la­tion, send­ing it to the Assem­bly without a way to cover an an­nual price tag that could reach $400 bil­lion.

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