Trying to move past doubts on single-payer health care
I’m so disappointed in myself. I should be 100 percent supportive of establishing California’s own singlepayer health system, which means the government, not insurance, pays health care costs for all people. After all, the best Californians are for it.
California’s next governor, Gavin Newsom, has made single-payer central to his campaign. America’s next president, California U.S. Sen. Kamala Harris, is running on it. And good progressives — in unions, nonprofits and the Democratic Party — have made single-payer their No. 1 political litmus test. Any officeholder who doesn’t support it now faces recall and Twitter bullying.
So why do doubts keep springing to my diseased mind?
I confess that, in dark moments, I wonder whether single-payer is just a weapon for some political interests to use against opponents. But how can I think such a cynical thing when President-in-Waiting Harris recently assured us — as she cosponsored federal legislation to protect you from health insurance by making it illegal for your employer to provide it — that singlepayer is “a nonpartisan issue”?
Now, sometimes I get cynical and wonder how practical single-payer is, or whether it might be wiser to build on the existing system. I also think about the one-third of all Californians, and half of all California children, who are on Medi-Cal, California’s version of Medicaid, which means the government pays for their health care. The people in this smaller version of single-payer struggle to get care because there aren’t enough doctors and institutions that will serve them.
Then I start thinking about money — money! for shame! — and ask: Why doesn’t the single-payer legislation in California and in Congress explain how you pay for single-payer? Then I read these estimates that a singlepayer health care system in California alone would cost $400 billion, which is 2½ times the size of the state general fund.
That gives me an anxiety attack, since raising taxes requires a twothirds vote of the Legislature, which can be a little bit hard to get. And then I worry — I’m not proud of this — about my kids’ schools. The two big pieces of the state budget are education and health care, so when you see a big run-up in spending on health, the schools get hit, and teachers get laid off and instruction time gets cut.
But then I get ahold of myself, and listen to Bernie Sanders (who like all Vermonters knows California deeply), and I stop worrying.
Because California’s schools already do remarkably well with some of the lowest state funding levels in the country. So why would it matter if they’re cut further? Because everyone will be so much healthier under single-payer, the teachers will be able to teach more kids in less time, and the children will learn faster!
And after listening to single-payer advocates, I’m sure that this singlepayer health care will pay for itself; in fact, it will save money, because all the dough we spend on insurance and pharmaceuticals will just be replaced by new taxes, and the efficiencies will create savings. (Don’t sweat the details.) While there might be startup costs, this is California, with an economy the size of France’s. We’ve got plenty of money. If the taxes don’t come through at first, we’ll have a Kickstarter campaign. Or crowdsource it. Or make Mexico pay for it.
Since having those realizations, I’ve been totally behind single-payer — with the exception of one bad bender of doubts. My trigger for that episode was the housing crisis.
I was reading a UCLA Anderson report about how far behind we are in meeting Californians’ housing needs. And then I saw the news that, spurred by rising homelessness, Los Angeles and San Diego counties now have hepatitis outbreaks that constitute public emergencies.
So I couldn’t stop my mind from thinking: How can these fancy people running our state be talking about some pie-in-the-sky single-payer when they’re utterly failing to provide Californians with the most basic piece of the healthy life — shelter?
But then I realized I was stuck in the past. Just because our systems for education and housing haven’t produced enough of either doesn’t mean that single-payer health care won’t produce enough health care.
Then it hit me: All my doubts about single-payer are a form of illness, and that illness is itself the best possible argument for single-payer.
Because, clearly, I’m sick in the head. And if there were a cure, I couldn’t afford it.
So bring on single-payer. It will fix me, and good.