Single-payer is dead in the Golden State

Fiscal challenges have a way of making politicians more honest. California Assembly leader Robert Rivas recently threw cold water on the idea that California could create its own single-payer healthcare system any time soon.

“The concept of singlepayer and expanding access and affordability are good ideas,” Rivas told reporters in Sacramento late last month, according to reporting by the Los Angeles Times. “I say this with great respect to stakeholders and advocates: We need to see how this is funded. It’s a good idea but it’s a tough, tough sell, especially in a budget climate that we are experiencing now.”

Indeed, calling it a “tough, tough sell” on just a dollarsand-cents level is understating things. The nonpartisan Legislative Analyst’s Office recently increased the state’s projected budget deficit from $58 billion to $73 billion, mostly due to ongoing shortfalls in projected tax revenue collection.

For reference, the governor’s budget proposal for next year calls for just over $200 billion in total general fund spending. Then consider the estimated cost of a single-payer system in California, which the state-established Healthy California for All Commission estimated about $500 billion.

Obviously, that’s far greater than the entire state general fund budget, and remains so even if one assumes the federal government would go along with redirecting Medicare and Medicaid money to cover $200 billion of that.

The state of California can’t even stay on a sustainable budget course with the comparatively smaller (though still massive) budget it already has.

The state’s perpetual fiscal problems in turn are a reflection of the poor quality of governance in Sacramento. We have a governor more interested in campaigning for president than ensuring the state of California is actually moving in the right direction. We have a Legislature that is dominated by one party and treats the legislative and budget processes as mere formalities.

Even if one concluded a single-payer system for health services was a good idea, the quality of governance in California should lead any rational reviewer to conclude that the Golden State just isn’t capable of handling such a responsibility.

If the state can’t figure out how to balance the budget it has now, and has to resort to budget tricks and steep cuts to make things work, imagine the negative consequences of handing control over our health care to the state.

Many moderate Democratic lawmakers are willing to admit this, some even publicly. But for too long, state leaders have dangled the promise of single-payer before progressive activists and people who simply think a single-payer system would be nice to have.

It’s time for more of California’s lawmakers to speak soberly and directly about what is and is not possible, both from a fiscal perspective and from a governance perspective.