Why Single-Payer Healthcare is the Solution After All: What California Can Learn from Massachusetts

By Carlyn Suzanne Obringer

Argument as to why the California Legislature should fully support the California Health Insurance Reliability Act (SB 840) to cure California's health care malady, rather than attempting to adopt Massachusetts' ambitious and incomplete model for universal coverage.

While HB 4850 does expand Medicaid eligibility and assist low-income residents who lack insurance by offering subsidies to purchase private coverage, the bill punishes middle-income families by putting those who currently have employer-sponsored health care at risk. Although cooperation among employers and employees is vital to any solution, the Massachusetts plan forces middle-class workers whose employers do not provide coverage, those who earn income at three times the poverty level, to pay up to 20 percent of their income for heath insurance or incur a penalty on their state income taxes. HB 4850, however, offers no financial assistance to these workers even though no cap on how much insurers can charge has been put in place. At the same time, HB 4850 creates an economic incentive for many companies to adopt minimal coverage, high-deductible policies, or no policy at all--companies with more than 10 employees who don't provide any coverage can simply pay a $295 per employee annual fee.

Despite the obvious flaws of the Massachusetts plan, Assemblyman Joe Nation (Sonoma-Marin) has, over the past two years, authored two bills to create a mandated insurance system in California similar to HB 4850. After AB 1760 was defeated in committee, Nation authored AB 1952, which would force the 6.5 million Californians who cannot afford health insurance to purchase minimal coverage that could exclude rights guaranteed under the Patient's Bill of Rights, such as immunizations and prenatal care, or lose their tax refund. Rather than following Massachusetts' example, adopting individual purchase mandates in a state dominated by for-profit insurers, California should instead turn to a real solution: a state-run, single-payer system.

The California Health Insurance Reliability Act (CHIRA), SB 840, sponsored by Senator Sheila Kuehl (Los Angeles), is a true universal coverage model that would use the bulk purchasing power of the sixth largest economy in the world to buy prescription drugs and medical equipment at an estimated $20 billion savings statewide. As the single insurer, the state of California would establish a comprehensive insurance plan--including dental, hospital, vision and pharmacy coverage, with no deductibles or co-pays, for citizens and undocumented workers alike--that requires no additional spending since all money spent on health care would come from a not-for-profit state fund. The state health plan would be headed by an elected health care commissioner with the power to establish a budget and impose fiscal discipline to contain cost inflation. The plan would not be socialized medicine, but, rather, a private health care system, under which health care and retail pharmaceutical sales would remain competitive, and doctors would reclaim the medical decision-making authority lost to insurance companies in recent years when ordering treatments.

Only a plan that consolidates health care financing and streamlines delivery, such as Senator Kuehl's CHIRA, that is similar to the single-payer model adopted successfully in Japan and Europe, can provide quality, sustainable health care for all. After all, in addition to saving money and establishing better coverage for every Californian, a single-payer system is very democratic, since all Californians would receive comprehensive health insurance, no matter their income level. A single-payer system has the support of consumers, labor, seniors and business leaders sick of the status quo. The time has come for Democrats in the Assembly to stand up to the insurance and drug companies and pass SB 840, true reform that will drive down the exorbitant cost of health care and save lives.