Democrats in California at odds over push for single-payer

In Democrat-dominated California, an intraparty fight is brewing over how to remake the state’s healthcare system. In one corner, advocates are trying to achieve universal healthcare by expanding the Affordable Care Act’s gains in insurance coverage. In the other, there are diehard supporters of moving to a single-payer system.

The state’s last proposal for a single-payer system came with a $400 billion annual price tag and no clear way to pay for it, on top of being criticized for giving providers little incentive to control costs by maintaining much of the fee-for-service payment structure. As Politico summarized, efforts this year have been focus on less dramatic reforms, like state-funded subsidies for insurance premiums, higher medical loss ratios for insurers and establishing a public insurance option.

Single-payer has largely been missing from the healthcare debate, with legislators pushing for more “pragmatic” policy goals. Advocates for single-payer call them “piecemeal” proposals.

“If our state health care system starts to implode because Obamacare itself collapses,” California Democratic strategist Garry South told Politico, “neither Democratic voters nor Californians at large will let the Legislature off the hook for having just tinkered around the edges.”

That makes supporting single-payer more of a political debate than a question of policy. It’s already become a major issue in the Democratic primary for the open governor’s office, with California Lieutenant Gov. Gavin Newsom backing the $400B single-payer bill while rival and former Los Angeles Mayor Antonio Villaraigosa calling it a “political press release.”

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