Single-payer health care in California would put a serious dent in the country’s uninsured population. (Courtesy photo)

Universal health care becomes a real possibility in the Golden State

As I write this, the GOP-controlled Congress is taking a second stab at repealing Obamacare. The effort is likely to fail, because the party is so divided. However, if they succeed, 21 million newly covered Americans may lose their health coverage. As we all know by now, this means that patients with pre-existing conditions, Medicare recipients and young people could be screwed.

And that threat has lit a fire under California, which is racing to send Congress a message: Health care is a basic human right.

Enter Senate Bill 562, the Healthy California Act, which promises to create universal health care in the state and which easily passed its first major legislative hurdle last week.

The bill would establish a publicly run health plan that would cover everyone living in California — all 39 million of us — regardless of immigration status. Co-authored by San Francisco’s own, state Sen. Scott Wiener and Assemblymember David Chiu (among others), the proposal would pay for all medical expenses, including inpatient, outpatient, emergency services, dental, vision, mental health, substance abuse treatment, acupuncture and chiropractic care.

Under the proposed plan, everyone would be covered, from undocumented residents to Medicare and Medicaid recipients to employees who currently get their health insurance through work. The plan is truly free of charge — no co-pays or deductibles. And you will be able to choose your doctor from a huge list of providers, rather than an insurer’s network.

It’s hard to tell if the quality of care will suffer. The program would be administered by a nine-member board, appointed by the governor and legislature, with an advisory committee of medical professionals and patient advocates — which sounds like a lot of bureaucracy to me. But the California Nurses Association, which is sponsoring the bill, said Healthy California’s benefits would be “equal to or better than most employer sponsored plans.” Hmm …

I have Kaiser, and I love it. Will I be able to keep my Kaiser doctors and facilities? Yes, but other insurance companies will mostly disappear, since they will only be covering things not paid for by Healthy California, like elective surgery and policies for nonresidents working in California.

Insurance companies are The Absolute Worst, so this is great news. But the plan sounds too good to be true.

Oh, and the sponsors haven’t figured out how to pay for it yet …

So-called “single-payer” systems work like this: Instead of buying health insurance and paying for premiums, residents pay higher taxes to pay for the plan. In the current proposal, monies will flow from many sources into the Healthy California Trust Fund, which will, in turn, be the source of all health care funding. Only one entity is writing the checks, which is why it’s called “single-payer.”

Some of this money will come from existing federal funds, some of it from state monies that pay for health care costs, and the rest from you and me. According to the bill’s proponents, 70 percent of all California health care spending is already funded by public money. But the remainder — gulp! — is a staggering number: $106.5 billion that will need to come from new tax revenue.

For context, the entire California budget is $124 billion this year. So, you know, this new program would almost double the state budget. No big deal.

But the biggest issue is this: California currently receives $261 billion in federal dollars to pay for Medicaid, Medicare and the Affordable Care Act and other health-related programs. So we would need the federal government — yes, the same federal government that’s talking about yanking the Affordable Care Act completely — to agree to divert those monies to our new universal health care program.

For now, these numbers are all just guesses. The bill’s proponents are conducting an economic study to figure out the precise dollar figures and their sources. The results are expected later this month.

In the meantime, it’s promising that we’re finally having the universal health care conversation. As Chiu told me, single-payer is “an important and exciting vision we need to explore, especially in light of the possibility that the ACA could go away.”

I find it utterly delicious that the GOP’s threats to repeal Obamacare could actually lead to universal health care for millions of Americans. As our state boasts the largest economy in the nation and 12 percent of the U.S. population, single-payer health care in California would put a serious dent in the country’s uninsured population.

There are clearly lots of details that need to be worked out, but the Healthy California Act is a very good start.

Alix Rosenthal is a municipal attorney, nasty woman and progressive activist who mentors and trains women to run for political office. She can be found on Twitter at @alixro and her blog is at

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