If California Adopts Universal Health Care, It Will Be a Model for the Whole Country

[applegrove]

by Paris Marx at Bold Italic

https://thebolditalic.com/if-california-adopts-universal-health-care-it-will-be-a-model-for-the-whole-country-f53b2bfea28f

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After spending years voting and pledging to repeal the Affordable Care Act (ACA), when the time finally came for the Republicans to replace President Obama’s landmark health-care legislation, they hopelessly failed. Their plan would have led to skyrocketing premiums for the elderly and taken away the insurance of more than 20 million people. Only 17 percent of the public supported the GOP plan, and it never even made it to a vote.

Still, it’s clear that our current health-care model isn’t working. At 16.9 percent, the United States is an outlier in health-care expenditure as a percentage of the GDP — the second highest being Switzerland, at 11.5 percent—and the only country not to have a highly regulated universal system. There’s reason to believe that universal health care could significantly reduce total spending on health care. And Democrats and progressives need to proactively present an alternative to the ACA.

California may be the state to show the way forward. In February, Senate Bill 562 was introduced to create a single-payer health-care system that would cover all 38 million Californians. The program would eliminate copays and insurance deductibles, and “inpatient, outpatient, emergency care, dental, vision, mental health and nursing home care” would be covered. The funding specifics have not yet been provided, but this is still a significant step forward in the fight for universal health coverage.

Though governor Jerry Brown argued that single-payer would be unaffordable because California’s current system consumes 18 percent of the state’s GDP, California still has other prospects for universal health care. Gavin Newsom has promised to implement it if he becomes governor in 2018, though he’s not advocating a single-payer system. He plans to build off of Healthy San Francisco, a program he implemented as mayor in 2007. This program would fill in the gaps of the ACA by paying for those who do not have insurance, allowing them to visit community health centers and public hospitals for primary and preventative care, which has reduced overall health spending in San Francisco by catching severe diseases early and avoiding costly emergency-room visits.

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[MontanaMama]

1. I've heard rumblings of this

possibility in CA and/or a health plan across CA, OR & WA. I'd love to see it work. All three of those states are in the top 10 healthiest economies in the US. States like Mississippi and Arkansas are at the bottom and may not be able to afford to universally cover all their citizens. Interestingly - those states at the bottom also have really high rates of smoking and obesity.

https://wallethub.com/edu/states-with-the-best-economies/21697/

[haele]

2. Hmmm. I've got some concerns on how this is going to work.

If the ACA went away, the majority of Californians will get their healthcare either through employers or through the Federal Government.
There's a couple issues here that need to be resolved for either Healthy San Francisco or Single Payer to work in California...
And Single Payer probably has a better chance than Healthy San Francisco, which seems to be more of a stop-gap Urgent Care/Medi-Cal referral situation than actual full health care. California needs to promote something that will provide the best bang for the buck in a Universal manner.

1) Provision. Are we going to go with an Insurance Company, or leverage existing administered Government programs such as the VA or Tricare (which, unfortunately does have a private partnership on a regional basis).
I would suggest replicating and tweaking the Tricare model, maybe working with (urgh) one of the Blues instead of Kaiser for the Hospitalization, Mental Health, Formulary, Vision, and Dental, much like Tricare does. Would be nice if they added hearing aides, too.

2) Funding. If the State agencies and all employers in the state are allowed to participate or "buy into" a Universal California coverage plan for their employees as a "bundle" at a better rate (even slightly better) than what either the ACA or most insurance companies can provide because of the large coverage area, the increase in tax and fee revenue required to support such programs would be lower. Add a small tax incentive to sweeten signing up the first couple years.

This way, some of the up-front costs are covered during the transition period, and California can slowly wean the state off employer provided health care and into a managed Universal health care. As employers and agencies pay less and less of the health care costs (and in theory, give their employees more in wages), the citizens will hopefully be able to afford their own and family coverage via taxes and small co-pays under the system without an undue financial burden, similar to Canada's model. As California should be able to keep the administrative and overhead costs down by managing prices, there should be less waste in the system.
For those small employers who don't want to cover their employees or would rather pass the cost of health care to those employees because of a small revenue margin, no penalty. The employee will pick up health care coverage on his or her own.

3) Blowback from the "I don't want to pay for someone else's poor choices" or "You can't make me" crowd. Even though if they have insurance, they're already paying for other people's poor choices, or when they finally get sick, get injured, or get old, they're not going to want to be put on that ice floe to die as indigenous cultures supposedly did to members of the tribe that became burdens, they're going to cry and whine and threaten through courts and legislation. Especially if they had Cadillac insurance or have never used health care. There's a lot of Red-State types who can't abide their "culture" of being manly X-tian "I did it all myself through hard work" being disrespected. Despite the fact that 1) the last time any Californian ever did anything to make money "by themselves" was back in the 1920's, and 2) they're living in a state full of people with equal claims on critical resources to survive, not just the few people who think they're God's Gift to the Earth.
The State needs to be prepared for this blowback, and have valid arguments that they can use with the Central Valley/Northern California types who are already pissed about Water and Environmental regulations.
(And for heaven's sakes, don't even think about what will happen when they find out California won't exempt family planning, or other gender issues.)

Anyway, that's the three things off the top of my head that I can think of that will need to be addressed. There's more, I'm sure, and honestly, I don't trust California's initiative process to get it right. I trust the Legislature a bit more, but even then, there's a lot of Silicon Valley and Hollywood money that's pushing agendas, and it's not always a sure thing they'll actually try and get it right without a profit in mind.

Haele

[eleny]

3. Here in Colorado voters turned it down last November

Some people here can be such dummies. I hope it comes up for a vote next time.

Meantime, good luck to California!