Introductory letter: Asking the important questions

By Sandra Hernandez, M.D., President and CEO
California Health Care Foundation, November 2017

California’s health care system has made great strides under the Affordable Care Act. Among many signs of progress, the state’s uninsured rate has been cut in half to 8.5%. Universal coverage in California is finally within reach, a goal that seemed like a long shot just five years ago.

Even with this progress, much work remains. Every Californian should be covered with a comprehensive set of benefits. We can and should do this while also ensuring that care is both affordable to California consumers and that the state’s health care budget does not crowd out other key state investments. Care must be easy to access, evidence based, and patient centered – regardless of a person’s place of residence, race or ethnicity, or type of health insurance.

Achieving universal coverage alone will not get us there, but the reforms needed to tackle costs, access, and quality are more likely to be successful when everyone is already included in the system.

There are many policy approaches to achieve universal coverage. Over the past year, mirroring growing national interest around a single payer system, there has been increasing momentum in California to create a state-based single-payer system. Our health care system affects tens of millions of lives, provides hundreds of thousands of jobs, and costs hundreds of billions of dollars each year. Any time major reforms to that system are proposed, a rigorous analysis is warranted.

The California Health Care Foundation (CHCF) commissioned this paper to provide a basic understanding of the core features of a state-based single-payer system as well as the major issues and values at play in the creation of such a system. The report does not take a stance, nor does it analyze specific single-payer legislation or proposals. Instead, it provides a baseline understanding of what a “single-payer” system is, what it isn’t, and what it might mean for California.

Like any policy, the feasibility and effectiveness of a state-based single-payer system in California ultimately depends on the problem it is attempting to solve. Different goals trigger different tradeoffs, as well as a variety of nuanced implementation choices. The paper surfaces what some of these tradeoffs might be. In doing so, it raises key questions that need to be answered about any single-payer proposal for California. Some of these questions are the same questions that should be asked about any major health care reform policy; others are more specific to implementation of a single-payer system.

It is our intention that this publication be a valuable resource across the political spectrum, as California’s Select Committee on Health Care Delivery Systems and Universal Coverage, and other key stakeholders, grapple with how to best move our health care system forward.

Regardless of your views on single payer, we encourage you to ask the important questions and consider the opportunities and challenges they present. By taking that approach together, we can start to gain clarity about what we are ultimately trying to achieve with further health care reforms – and what it will take to get there. This will only strengthen California’s chances of success, no matter what path we ultimately take to achieve universal coverage.

Full report (28 pages):…

Although this paper was written for California, most of the questions posed apply to any state that is considering enactment of a single payer system. It is specifically targeted to the Select Committee on Health Care Delivery Systems and Universal Coverage established by Assembly Speaker Anthony Rendon when he put on hold SB 562 – a single payer bill – because it was “woefully incomplete.”

Although the paper is not exciting reading for those well versed in single payer, its mere existence is of much greater significance. The California Health Care Foundation, which sponsored this report, was one of two foundations established when Blue Cross converted to a for-profit corporation and was required to return to Californians the tax benefits it had accrued as a nonprofit. The founding President and CEO, Mark Smith, had adamantly refused to cooperate with any consideration whatsoever of the single payer concept.

How far we have come. Sandra Hernandez, the current CHCF President and CEO acknowledges that much more must be done beyond the Affordable Care Act. By commissioning this paper on a state-based single payer system CHCF recognizes the need “to provide a basic understanding of the core features of a state-based single-payer system as well as the major issues and values at play in the creation of such a system.”

The report states, “A single-payer health care system in California could help the state meet a number of goals — universality of health care coverage, comprehensiveness of coverage, greater equity, greater access and quality, improved affordability, lower administrative costs, and slower growth in health care costs.” No other model of reform can meet those goals.

This is more evidence of the fact that single payer has now become politically feasible.

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