Although Gov. Arnold Schwarzenegger has promised to veto the California bill, it could signal a change in the health reform debate, as proponents of health reform get frustrated with the national stage and move efforts to the states.
What happens to proposal now? The California Senate passed the bill by 22-14, with all but one Democrat and no Republicans voting for it. It now goes to the state Assembly, which has passed previous California single-payor bills, then to Gov. Schwarzenegger, who vetoed the previous bills. If passed, the bill would authorize $1 million to establish a commission to decide how to pay for the system.
How does this relate to national health reform? Democratic State Sen. Mark Leno, the author of the bill, said voters came to dislike Congress’ compromise health reform legislation. “Whatever comes out of Washington is much less certain, which only gives greater incentive for leadership coming from state legislators because somehow, some way, health care reform must be addressed,” Mr. Leno told the Huffington Post.
What do Californians think? Mr. Leno points to past polls that have shown support for a state-run plan. A new poll by the Public Policy Institute of California finds that 74 percent of Californians believe the state is headed in the wrong direction. This could be interpreted as a call for radical change or anger at current legislators, the people who passed this bill.
What do opponents think? “What a bizarre place I work in,” wrote Republican State Sen. Sam Aanestad, an oral surgeon, in the New American. Following the Massachusetts defeat, “Democrats who control the State Legislature in California revived their own universal healthcare bill. Didn’t they get the message I did?”
How might other states react? With the prospect of the Congress’ health reform bill failing, the health reform debate may now move to the states. Massachusetts has already enacted universal healthcare. Illinois, Oregon and Massachusetts have flirted with single-payor systems in state legislation and referendums, but all have failed so far.
Could it have a polarizing effect? There already is a wide gap between passionate proponents of a single-payor system, such as Physicians for a National Health Program, and opponents of government intervention in healthcare. Positions could harden if the federal health reform bill, which was supposed to bridge the divide, is not passed.
What exactly is a single-payor system? It involves creating a government-run or financed plan open to everyone. It may or may not be linked with elimination of private insurance and government-run health facilities. Canada and several European nations have various kinds of single-payor systems.
How would it affect physicians and hospitals? “I cannot support an under-funded program that would leave patients with far fewer options for care than they have today,” Dr. Aanestad stated. The concerns are that a single-payor system could drive reimbursements down to Medicare levels and lead to waiting lines for certain services, as occurs in the Canadian system. Some U.S. physicians are already bailing out of Medicare, the U.S. single-payor system for the elderly, because it pays too little. But others argue that a single payor would be a boon for healthcare, providing a massive infusion of new paying patients and improving health status by detecting diseases earlier.
Could it reduce insurance premiums? Paul Krugman, a New York Times columnist who supports a single-payor system, has argued the arrangement could curb premium growth by eliminating the costs of insurer-middlemen and by extending coverage to healthy people who are less costly to the system.
Would it add to California’s budget deficit? The state faces a $20 billion deficit. The California Legislative Analysts Office said the single-payer proposal would cost $200 billion, or more than $5,000 in new taxes for every Californian. But Sen. Leno argued that Californians already pay $200 billion for their healthcare through premiums and other funding. He said the system could be funded through a payroll tax, existing state and federal funding and increased efficiencies by eliminating the insurer-middleman.
