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Single Payer in California? Can We Afford it? Can We Afford Not to?


Single Payer in California? Can We Afford it? Can We Afford Not to?

Paul Song

Yesterday the California State Senate Appropriations Committee released their fiscal analysis of SB562 sponsored by Senators Lara and Atkins. Opponents immediately screamed that #SB562 would cost $400 billion per year, more than three times California’s $124 Billion general fund budget for next year.


With all the SUPER WEALTHY who are moving to our state of CA and clogging up our coasts with their ultra-huge mega mansions, I say let’s tax them for their gluttony so we can have a well-funded single payer system. They came to California, claim our beautiful coastlines, clog our roads with their cars – then they can PAY decent taxes on their yachts, property, etc. and we could get a good chunk for our single payer healthcare.


The article failed to mention the salient fact that the US spends far more per capita on health care than any other country. According to Wikipedia, the US spends double what Canada does ($9,500 vs. $4,600. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita), and Canada has a single payer system.

There would be large savings in administrative costs – I’ve heard it’s 15% in the US, 3% in Canada (and in Medicare also!). We could also save by the state buying pharmaceuticals, as they do in Canada.

The idea that converting to single payer would cost too much is absurd. It’s our current “system” that costs an arm and a leg.


Exactly. The current HC amalgam (not system) - which is already funded by 70% with tax money - is bloated, filled with inefficiencies and corruption, skewed toward high-cost technologies, drugs and therapies rather than actual public health outcomes and prevention, skimmed by profiteers etc.

While we probably could not get near Canada because of the power of private interests, we could easily cut existing costs by half with improved results in real human health,.


What this ultimately comes down to is not cost, but political will. Thus far the Democratic Party has not had the political will to support single payer. This is true even in California, where single payer has officially been on the state party platform for years. This is true even though single payer is broadly popular and will win Democrats votes and seats. The Party serves money first and foremost.

When you don’t want to pass single payer, then the $400 billion figure - which is an pharma/insurance industry talking point - is what you emphasize. This has been done repeatedly by corporate Democrats, right-wingers and industry hacks in other states too - most recently Colorado and New York.

When you want to pass single payer, you tell voters “you’ll pay less in taxes than you pay now in premiums, co-pays and deductibles. And you’ll get better coverage.”

This is not complicated messaging. It’s actually quite simple. But the Party is compromised by industry money, so don’t expect Dems to do it.

If the Party is going to support single-payer, in California or anywhere else, activists are going to have to drag it kicking and screaming to that end. Winning moral arguments won’t be enough, and being right on the facts won’t be enough. We’ve been morally and factually correct for decades now… and lost. Only power will win on this issue.


Yes, I was curious whether the numbers took account of this. Surely we will pay the lowest negotiated rate, equivalent to Medicare? To my estimate, that cuts the cost by at least 2/3rds.


Absolutely spot-on post!!! And this is true of all issues. Power wins. Not “morality,” facts or “arguments.”


The figure of $400 billion makes no sense as that is $10,000 per capita. What we’re paying now with the private insurance companies, the drug companies, everyone else ripping off the people for their own profit. Since state governments license health care providers, the state should be able to push those figures down quite a bit. Then the State of California would look into removing the laws and regulations that make health care so expensive in this country. There are also the state laws regarding medical malpractice that could be “reformed”. So there are a whole lot of things a state can do (if it wants to) to reduce health care costs far below that $10,000 per capita figure that has been tossed around.


I think your math is off by a factor of 10. The US population is about 325 million, so $400 billion per 325 million would be about $1,200 per capita.


Population of California is 40 million. $400 billion would be $10,000.


Oh, I see. I thought you were referring to the US. You are correct.


Healthcare is expensive, that’s just a reality. The discussion right now is financing the bill via a 15% employer payroll tax. This is not going to go well and in California, where we pass ballot measures like notes in classrooms, it’s going to need balanced financing and broad support to not get overturned by voters. So, if that’s split between employer and employee, you get roughly double the average California health insurance premium per individual a month (statewide average via Kaiser is $225). So, for an individual making $65,000, it’d be about $406 a month. Depending on your employer contribution, that may or may not be a good deal.

The problem with the $400 billion estimate is that it assumes federal financing will remain constant. That, of course, could be a dangerous assumption. I would love to see single payer happen, but the financing issue is always where things get thorny and voters get nervous. We need majority support for the plan, so a satisfactory situation has to be worked out. Let’s cross our fingers and hope that can happen. The truth is, we are a ways away from it at the moment.