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Friday, May 05, 2017

California moves forward while Washington DC goes backwards

Although I've been understandably dismayed by the horrible show of "bravado on steriods", given the Republican health care insurance vote, the Los Angeles Times has given my some oxygen for hope.  Although this opinion is justifiably a skeptical point of view, the fact is, the single payer bill passed out of committee and is now up for debate in the California legislature. 

“Single Payer” refers to a way to pay for healthcare. Instead of having hundreds of different private health insurance companies and thousands of different insurance policies, coverage would be standard and there would be one agency that would pay the bills. That agency could be a public or quasi-public agency or a private corporation acting as a subcontractor to the public agency. 
By George Skelton- Although he only gets some of his opinion right, he calls for "bold action", and I agree.

Heal CA
Voters want politicians to be bold. They disrespect timidity. And trying to push every Californian into a government-run healthcare system is certifiably bold.

The voters’ desire for boldness has a caveat, of course: They’ve got to like what the politician is being bold about.

We really don’t know how Californians feel about government-run universal healthcare- or a single payer system. But the policy is currently being debated in the California legislature.

The Public Policy Institute of California surveyed voters in January, however, and found that 54% opposed congressional repeal of the Affordable Care Act, or Obamacare.

But for generations, it has been the dream of many to enact whatever you want to call it: “single-payer,” “Medicare-for-all” or “socialized medicine.”

Now, with congressional Republicans and President Trump trying to repeal and replace Obamacare, some Sacramento Democrats think they see an opening to finally adopt a California version of single-payer.

Under single-payer, healthcare costs are paid for by a plan designed by the government, including by private insurances. The healthcare itself is still delivered by private physicians.

“Medicare-for-all” is a viable option for a single payer insurance because it's already in the law and presumably could fit into the system envisioned by supporters.

The bill declares: “It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer healthcare coverage program and a healthcare cost control system for the benefit of all residents of the state.”

Medi-Cal, the state’s enhanced version of federal Medicaid for poor people, covers immigrant children but not their parents.

Dreams can be good. But this dream — especially with Trump and conservative Republicans controlling the national agenda — seems like wishful fantasy, even in deep blue California.

The envisioned policy long has made sense. Cut out the insurance industry profiteering and reduce healthcare costs. Perhaps eliminate co-pays and deductibles.

Even Medicare-for-all would be better than what most people have today. Ever hear a senior seriously complain about Medicare? I haven’t.

Most industrialized nations have some sort of government-run healthcare coverage — either single-payer or a hybrid public-private system.

But good policy aside, there are two huge obstacles to a state going solo: financing and politics.

In California, it would cost the state tens of billions of dollars. Who’d pay for that? Business, which presumably would no longer need to provide employees with health insurance? Wage earners through payroll withholding? Medical providers? How much would the federal government kick in? Anything?

That presumably will be in the bill’s details. Good luck.

And how would this legislation ever get passed? The politics are daunting. The insurance industry would fight with all it has — meaning campaign money. So would many healthcare providers that historically have feared “socialized medicine.”

On the other side, the California Nurses Assn. is the bill’s chief sponsor.

But nothing of this magnitude and controversy can pass the Legislature without a committed governor pushing strongly. And Gov. Jerry Brown hasn’t said a peep about single-payer healthcare since he was elected in 2010. Moreover, the normally cautious skinflint is not likely to commit the state to such a financial gamble.

No other state has a single-payer plan (yet). Vermont did briefly, but scrubbed it in 2014 because of high costs and unpopular taxes.

The California Legislature passed a single-payer bill — sort of — when Arnold Schwarzenegger was governor, but he vetoed it.

Actually, it wasn’t a real single-payer plan anyway. It didn’t include any financing. That was to be passed later and required a two-thirds supermajority vote. No way.

Updates from Sacramento »

Democrats currently hold a supermajority in each house. But you can bet not all are inclined to vote for a tax increase. Possibly for highway repairs, but not for an untested, radical change in healthcare coverage.

“The time is right, the time is now,” insists Lara, who’s thinking about running for state insurance commissioner next year. “California can be the national laboratory for our country.”

“What everyone agrees on,” he adds, “is we need to have an alternative” to threatened Obamacare.

But many Democrats believe their best hope is congressional gridlock and the blockage of repeal.

“Perhaps I’m like Alice in Wonderland, but I really am hopeful,” says state Sen. Holly Mitchell (D-Los Angeles), the Budget Committee chairwoman. “There’s an amazing groundswell of people showing up all over the country fighting to retain the Affordable Care Act.”

What about single-payer? “I honestly don’t know.”

Not a lot of enthusiasm there.

She sounds like other Democrats who privately believe the focus should be on preserving what they can of Obamacare, which has pumped nearly $24 billion annually into California healthcare and halved the number of uninsured.
Bold is good. And it’s good some people are promoting universal healthcare. But whatever they, if there's no funding, it's fantasy.

MaineWriter- I'm hoping California will lead the way and begin the trend for single payer with Medicare for All as the preferred model. It's hopeful to see California move forward while Washington DC Republicans grind backwards.

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