The California Senate recently voted to approve a bill creating a state-level system of single-payer healthcare. It’s doubtful that the bill will become law, because it is opposed by Governor Jerry Brown. But the various left-wing interest groups are nonetheless backing the effort with substantial political resources.
Strictly speaking, single-payer health insurance means that only the government–nobody else–pays for health care. That means no private insurance. So Canada, for example, has banned private insurance. People, however, often use the term single-payer loosely to refer only to a government-paid option–what Nancy Pelosi calls ‘the public option’–that operates alongside private health insurance, as in the U.K. I therefore expected that the California Senate must have voted for a public option, but was surprised to find that, no, they literally meant single-payer. The California Senate actually voted to outlaw private health insurance.
If I like my plan, can I keep it?
Not unless you go to the VA, the only non-Healthy California system that would remain in place. Private insurance would no longer exist. The roughly 50 percent of people who get insurance through their employers would switch over. Medicare, the federal program that provides insurance for the elderly, would cease to operate in the state. So would Medicaid, which insures low-income people. Companies would be banned from selling any form of supplemental insurance that covers the same things as the state’s program. It is single payer after all, with the singular entity being the California government.
Note the distinct rollback in the freedom and autonomy of the individual. If you like your plan, tough luck, you’re forced to enroll in the system whether you want to or not. Your employer might want to offer health coverage as a benefit, and you might be happy to accept it, but the state says no, you can’t do that. Or you might want to purchase private insurance on your own so you won’t have to rely on the state, and an insurance company would willingly sell you an acceptable plan. But the state says no, you can’t carry out that transaction. The citizen is transformed from a paying customer with some degree of autonomy into a supplicant of the state. If that’s freedom, then zoo animals must all be free–they don’t pay for their medical treatment either.
In any event, I still find it hard to imagine that California would ever operate a literal single-payer system, because it would mean that the privileged Hollywood and Silicon Valley elites would have to seek treatment out-of-state. No way would the elites submit to the waiting lists, restricted access, and deteriorating standards that will inevitably accompany a cash-strapped single-payer system. It’s one thing for the peons to go on waiting lists, but not Jimmy Kimmel’s son. So it will be interesting to see how the elites preserve their privileges.
But let’s get back to the actual bill on the table.
The legislation guarantees free government-run health care for California’s 39 million residents—no co-pays, deductibles or insurance premiums—as well as virtually unlimited benefits. Patients could see any specialist without a referral and receive any treatment that their provider says is medically appropriate.
Sure. Just write those provisions into the law and it will all come true. What could go wrong?
How will all this be paid for?
A University of Massachusetts Amherst study commissioned by the California Nurses Association—which favors government-run health care—claims that single-payer would reduce health-care spending by $37.5 billion a year. This miracle would be achieved largely by slashing administrative costs as well as provider and drug reimbursement rates.
So the California Nurses Association is pushing a plan that involves slashing payments to ‘providers.’ Last time I checked, those ‘providers’ also happen to be the employers that most nurses work for. Hard to see how dealing a huge financial blow to their employers will benefit nurses. If I were a nurse in California, I’d be concerned that the union leadership was selling me out. In most countries with single-payer healthcare, nurses get paid a lot less than they do in America. In France, for instance, nurses are paid less than half as much as in the U.S.
The study also asserts that California could reallocate $225 billion a year in Medicaid, Medicare and ObamaCare spending for single-payer assuming a federal waiver. Thus the legislature would only have to come up with $107 billion.
‘Only’ $107 billion. For perspective, California’s entire state budget right now is $124 billion, so even under the nurses’ rosy scenario, the burden of state government would nearly double.
The Power Line blog highlights the comments of Wall Street Journal reader Craig Harrison, a California resident.
Can the state really commandeer my federal Medicare benefits?
When it takes 3-6 months to see a physician in California, can the state stop me from going to Nevada, Arizona or Oregon for care? Will they put me in jail if I do?
Assuming the state is not required to reimburse you for your out-of-state expenses, I assume they would welcome being relieved of the burden. They’re happy for you to pay your own way out-of-state while still paying taxes to support the California system you’re not using.
How many miles offshore need a hospital or clinic ship anchor to be outside of the reach of the state?
Maybe the Queen Mary, permanently anchored at Long Beach, can be converted into a hospital ship.
If California ever does install single-payer, they can expect to experience a very bad selection effect on net migration. The most productive citizens will seek to avoid the tax burden by fleeing the state, while poor and sick people flock to California to take advantage of the freebies.
It’s also worth noting that this is not the first attempt by a state to create something like single-payer. Not too many years ago, attempts in Tennessee and in Vermont had to be abandoned due to the very daunting practical difficulties. Despite these failures, California leftists somehow imagine that they can make it work. Cuz they’re special or something.