The state Assembly’s Health Committee advanced Assembly Bill 2200 this week. The bill would ban private health insurance and force all state residents into “CalCare,” a government-run health plan. Nine Democrats voted aye, four Republicans voted no, and three Democrats abstained.
The measure now heads to the Appropriations Committee. But AB 2200’s odds of becoming law are still long. The state simply can’t afford the hundreds of billions of dollars it would cost each and every year.
That’s a good thing, because single payer invariably results in long waits for subpar care.
Single payer has been a hobbyhorse of California Democrats for years. In 2017, the California Senate gave the thumbs-up to a similar single-payer bill. But then-Assembly Speaker Anthony Rendon refused to move it forward in his own chamber, because the law had no mechanism to cover its staggering $400 billion annual price tag. In 2022, another single-payer bill died in the Assembly before it could go to a vote.
We’re experiencing déjà vu all over again. Assembly Speaker Robert Rivas recently expressed “concern” about the state’s ability to pay for AB 2200, especially given that California currently faces an estimated $73 billion budget deficit.
The funding plan for AB 2200 is fantasy. The bill’s supporters are banking on a waiver from the federal government that would allow the state to divert all the money it uses for Medicare and Medicaid into this new “CalCare” scheme.
It’s highly unlikely Washington would accede to such a request. Even if it did, AB 2200 would still require a raft of tax hikes on businesses and households across the state. Prior efforts to impose single payer have proposed new gross receipts taxes on business revenues, payroll taxes on employers, and much higher marginal tax rates on households.
Two years ago, the projection was that state tax revenue would have to double — and the average household’s taxes would soar by $12,250.
According to a new study from my Pacific Research Institute colleague Wayne Winegarden, such tax increases would have dire economic ramifications. Just five years after implementation, single payer would cause California’s economy to be nearly 3% smaller and have 332,000 fewer jobs than otherwise expected. Average household incomes would be $1,200 lower.
Democratic Assemblywoman Pilar Schiavo commented during the hearing that it’s really not debatable today that single payer saves money. She apparently has some reading to do.
Then there’s the devastating impact single payer would have on patients. One need only look to Canada and the United Kingdom to see what government-dominated health care looks like in practice.
The median wait in Canada for specialist treatment following referral by a general practitioner is more than six months. As of January, nearly 7.6 million people in England were on waiting lists to see a doctor.
To keep a lid on costs, CalCare would slash reimbursement rates for physicians. That would prompt doctors to flee to other states. Democratic Assemblywoman Akilah Weber, a medical doctor, expressed concern that the bill’s payment rates would not be sufficient to keep doctors in California — or attract new ones. “We already have a provider shortage, and if we don’t do this correctly, we’ll just worsen that,” Weber said.
Speaker Rivas seems to understand all this. He’s called single payer a “tough, tough sell, especially in a budget climate that we are experiencing now.”
The Assembly Appropriations Committee will eventually have to acknowledge that math. So the political conventional wisdom is that the Appropriations Committee will be the end of the line for single payer this time.
Under this scenario, AB 2200’s progressive supporters will still get to crow that they are fighting for single payer. Establishment Democrats — including Gov. Gavin Newsom — won’t have to take a position on a controversial bill during an election year.
The losers, of course, are ordinary Californians, who can be forgiven for wondering why their elected officials are wasting time on pipe dreams like single payer — rather than addressing things that actually affect their lives, like the state’s high cost of living and lack of affordable housing.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on X at @sallypipes.