STATE-ONLY SINGLE-PAYER PLAN IS A FANTASY

The San Diego Union-tribune Editorial Board has supported a single-payer government-run health-care system for years. The devotion so many Republicans have to the current system is hard to fathom. For all the complaints about the prospect of “socialized” medicine, no single-payer critic ever acknowledges the fact the U.S. already spends more per capita on government-funded health care than any nation in the world, including those with singlepayer systems like Great Britain and Canada. Despite this heavy spending, U.S. health outcomes are generally worse than in other large industrial democracies, with one prominent exception being cancer treatment. Some 20 percent of U.S. health spending goes to marketing, underwriting, administration and profit — much higher than in the rest of the world. That’s ridiculous. That’s wrong.

But in 2017, when Assembly Speaker Anthony Rendon, D-lakewood, effectively killed a bill creating a state single-payer system, we applauded. The measure didn’t explain how to cover its estimated $400 billion annual cost — much more than the state’s general-fund budget. It was an exercise in fantasy. Off the record, many Democrats were honest about the only way California could afford its own single-payer system: If the Golden State were to receive a bulk payment from Washington, D.C., equivalent to all the federal health care funds that would otherwise be spent on state residents through the Affordable Care Act, Medicare, Medicaid and other programs. But a 2019 proposal to allow California and other states to get such funds to set up their own systems went nowhere.

Still, with more than 3 million state residents uninsured, interest in single-payer in California has never flagged. Now such legislation is advancing in the Legislature again, except this version explains how it would be funded. On Tuesday, the Assembly Health Committee gave initial approval to Assembly Bill 1400, crafted by Assemblymember Ash Kalra, D-san Jose. It would scrap private insurance and federally provided coverage in favor of a massive state system called Calcare.

It would be partly funded by a companion measure containing by far the biggest hike in state taxes in U.S. history — at least $163 billion. If ratified by state voters after winning two-thirds support in the Assembly and Senate, Assembly Constitutional Amendment 11 would impose a new excise tax on businesses equal to 2.3 percent of any annual gross receipts in excess of $2 million; a new payroll tax for employers with 50 or more employees at a rate of 1.25 percent of total wages; and an additional 1 percent payroll tax on employers with workers earning more than $49,900 a year. Californians’ income taxes would be raised for annual salaries above $149,509 a year, with an initial 0.5 percent, going up 2.5 percent for those with salaries above $2.5 million.

Sorry, but this still feels like a fantasy. Even with the $163 billion in new taxes, the financing only pencils out with the federal block grant proposal that went nowhere in 2019. Gallup polls have a history of showing most Americans are satisfied with what they pay for health care, though the numbers fell significantly during the COVID-19 pandemic. There perhaps hasn’t been a better time to study singlepayer health care, but people aren’t going to vote for a massive increase in taxes for a program run by a state that sent billions of dollars in unemployment checks to convicts with prison addresses.

By contrast, Gov. Gavin Newsom’s far more modest proposal is practical and achievable. It would spend $2.2 billion a year to extend Medi-cal coverage to the estimated 764,000 undocumented immigrants in the state ages 26 to 49. Other undocumented individuals are already eligible for Medi-cal.

Bold plans will have more appeal to progressives who want major changes, only starting with health care. But bold plans with no chance of passing are a waste of time. We applaud lawmakers who want expanded access to health care. But their energy is best spent on ideas with a chance of being enacted.