Single payer can’t happen in California. At least, not right away
By Steve Tarzynski
Los Angeles Times, July 25, 2017
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time.
But by 2020, California might just be ready for single payer — if advocates achieve a string of smaller but important legislative victories to build power.
Such steps might include: a state individual mandate; a state employer mandate that also covers part-time workers and their dependents; continued guaranteed coverage for children in the country illegally; giving the state insurance commissioner the power to regulate insurance premiums; setting a process to negotiate drug and medical device pricing; administrative reforms to streamline Medi-Cal so that there is less waste and better coordination and continuity of care; engaging the state’s tech sector to assist with such streamlining; advancing nonprofit delivery systems and moving away from fee-for-service practice; and opening up Medi-Cal to everyone, which would effectively create a state public option robust enough to compete on a level playing field against private insurers.
We do not need yet another devastating loss. Time, treasure and effort would be better spent winning the series of smaller victories that create the pathway to single payer. And in four years, a substantially stronger single-payer movement could successfully lobby a new Congress and president for federal waivers.
More than a century ago, Theodore Roosevelt called for a system of national health insurance. Single-payer advocates have been working for decades. They’ll have to work a few years more.
Steve Tarzynski is a physician and president of California Physicians Alliance.
(For a fair representation of Steve Tarzynski’s views, be sure to read the full article available at the link below.)
By Don McCanne, M.D.
How much incremental reform do we need before we are ready to enact a single payer system, whether at the state or federal level? Or are we ready now?
The California chapter of Physicians for a National Health Program (PNHP) struggled with these questions without resolve, and it was decided to split the chapter into two organizations – PNHP California and California Physicians Alliance (CaPA), CaPA having been a predecessor organization in California. PNHP is a single issue organization advocating for single payer reform whereas CaPA advocates for incremental reforms with an ultimate goal of single payer.
There is legitimacy for both organizations.
CaPA leadership believes that advocating for incremental reforms would establish a better working relationship with other organizations supporting health care justice. Joint advocacy efforts supposedly should reduce the resistance to the more comprehensive reform that a single payer system would bring us. More importantly, incremental reforms can be beneficial during the interim before transition to a single payer system clears the political hurdles.
PNHP leadership believes that we should do all that we can to expedite the transition to a bona fide single payer system. We have a long history of incrementalism and each step has resulted in postponement of a serious consideration of single payer. Right now the battle in Congress is between supporting the incremental policies in the Affordable Care Act or replacing them with measures that would set us back even further. Yet the concept that the government should play a greater role has gained traction amongst Americans, and we should be moving forward with a process that will accomplish that instead.
There are many individuals and organizations who support the various incremental proposals. They do not want for lack of a voice. On the other hand, there is a need for a loud, clear and unwavering voice for single payer reform, lest the message be lost in the incremental mishmash. PNHP will remain a major contributor to the clarion call. CaPA should as well though Steve Tarzynski in his op-ed says that fighting for single payer in the immediate term is a waste of time. But if we expect results by 2020, there is much work to be done now.
For full disclosure, I should say that I am a member of the transitional steering committee for PNHP California as we revitalize our chapter, and I am also a member of the advisory board for CaPA. I believe that both organizations play important but somewhat different roles in the California health care reform movement.
As a former national president of PNHP, I do have a bias. Both organizations support single payer as the ultimate goal, and I am going for that. I do support beneficial measures that may provide transitional relief, but devoting time, resources, and effort to single payer is not a waste of time; it is an absolute moral imperative. We need to go all out, now!
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