Let me begin by saying I have never lived in California. I don’t know exactly how the state government works, and I don’t generally pay close attention to California news. If that’s true for you, too, then let’s explore this together.
A few days ago there were news stories about California possibly moving to a single-payer health care system within the state. There was a bill moving toward passage, the news stories said. Then there were stories about the bill being killed by California Assembly Speaker Anthony Rendon. In progressive circles the death of the bill was attributed to Rendon’s being a corporate stooge who took money from the medical industry. David Sirota wrote in International Business Times,
As Republican lawmakers grapple with their unpopular bill to repeal Obamacare, Democrats have tried to present a united front on health care. But for all their populist rhetoric against insurance and drug companies, Democratic powerbrokers and their allies remain deeply divided on the issue — to the point where a political civil war has spilled into the open in America’s largest state.
In California last week, Democratic state Assembly Speaker Anthony Rendon helped his and his party’s corporate donors block a Democrat-sponsored bill to create a universal health care program in which the government would be the single payer.
Rendon’s decision shows how progressives’ ideal of universal health care remains elusive — even in a liberal state where government already foots 70 percent of the total health care bill.
Now, you all know David Sirota’s work, I suspect. I’ve been reading his stuff for years. He’s one of “our” writers. Sirota goes on to say that although the bill had passed in the state senate, Rendon had quashed it before it could go on to the state assembly. Sirota continues,
Since 2012, Rendon has taken in more than $82,000 from business groups and healthcare corporations that are listed in state documents opposed the measure, according to an International Business Times review of data amassed by the National Institute on Money In State Politics. In all, he has received more than $101,000 from pharmaceutical companies and another $50,000 from major health insurers.
In the same time, the California Democratic Party has received more than $1.2 million from the specific groups opposing the bill, and more than $2.2 million from pharmaceutical and health insurance industry donors. That includes a $100,000 infusion of cash from Blue Shield of California in the waning days of the 2016 election — just before state record show the insurer began lobbying against the single-payer bill.
Well, that’s pretty damning, isn’t it? Another reason Dems always lose.
I didn’t think anything more of it until I read this article by David Dayen at The Intercept that gave a different view.
IN THE DAYS SINCE California Assembly Speaker Anthony Rendon shelved for the year SB562, which intends to establish a state single-payer health care system, he’s been subject to mass protests and even death threats. The bill’s chief backers, including the California Nurses Association and the Bernie Sanders-affiliated Our Revolution, angrily point to Rendon as the main roadblock to truly universal health care.
They’re completely wrong. What’s more, they know they’re wrong. They’re perfectly aware that SB562 is a shell bill that cannot become law without a ballot measure approved by voters. Rather than committing to raising the millions of dollars that would be needed to overcome special interests and pass that initiative, they would, apparently, rather deceive their supporters, hiding the realities of California’s woeful political structure in favor of a morality play designed to advance careers and aggrandize power.
And I’m thinking, holy bleep, what the bleep is going on here?
Did I mention this is David Dayen? I’ve been reading his stuff for years, too. He’s good. And he is known to be a wholehearted supporter of single payer healthcare.
Having done some digging, I’ve come to think the bill, SB562, was never a serious bill. It was more about grandstanding and legislative theater than actually initiating single payer in California. I could be wrong, but that’s what it looks like.
Kevin Drum at Mother Jones provides some background.
Funding. Single-payer would cost something like $200 billion, give or take a few billions. This is nearly double the entire state budget, but SB562 blithely ignored it. It included no funding mechanism at all, and simply passed that responsibility to the state Assembly. It’s not surprising that Rendon was reluctant to shoulder this on his own over the course of the next few months.
Prop 98. Like it or not, California has a school funding law put in place years ago by Proposition 98. It’s insanely complicated, but basically requires that 40 percent of the state budget go to K-12 schools. Using round numbers, if the state budget is $100 billion, school spending has to be at least $40 billion. If state spending goes up to $300 billion, school spending has to be at least $120 billion. Aside from being ridiculous, it also leaves only $120 billion for the health care bill. Oops.
As far as I know, there is no tricky way to get around this. It would have to be dealt with by a ballot initiative. That’s obviously not going to happen in this legislative session.
Waivers. This is the issue nobody pays attention to, but is probably the most important of all. To implement single-payer, California would need $200 billion in new funding plus $200 billion in federal money that currently goes to Medicare, Medicaid, veterans health care, and so forth. Without federal waivers to give California access to that money, the plan can’t go anywhere. As Duke University researcher David Anderson puts it, “If there aren’t waivers, this plan is vaporware.” What do you think are the odds that the Trump administration will grant all those waivers? Zero is a pretty good guess.
Along the same lines, Michael Hiltzik points out that self-funded health care plans are governed exclusively by federal law. That means California would need an exemption from the law. What do you think are the odds that a Republican Congress will grant that exemption? Zero again?
Kevin Drum and David Dayen are both Californians, I understand, so they know the ins and outs of how California works a lot better than I do. And if Kevin Drum is right, then even if the bill passed the assembly and were signed into law, it still wouldn’t be implemented. There is language in the bill that would stop it from going into effect if funding isn’t available, and because of all the reasons stated above, it currently wouldn’t be possible for the funding to be available.
So what, exactly, is the point?
If any state could make single-payer work it ought to be California, which claims to have the sixth largest economy in the world. But it appears to be true that SB562 contains no mechanism for funding, and this is one of the reasons Anthony Rendon delayed the bill. This doesn’t strike me as being unreasonable.
Let’s go back to David Dayen:
There’s a reason that every California single-payer bill in the last 25 years — and there have been at least seven, two of which passed the legislature and were vetoed, so we in the Golden State have seen this movie before — never includes a funding mechanism. It’s not necessarily because of fear of voting for higher taxes, or even the two-thirds threshold to increase a tax in the legislature.
It’s because you can’t do the funding without help from the voters, because of California’s fatal addiction to its perverse form of direct democracy. The blame, in other words, lies with ourselves.
To figure this out, you need only turn to the actual legislative analysis of the Senate bill, which passed in early June. It states very clearly what Rendon alluded to in his announcement shelving SB562: “There are several provisions of the state constitution that would prevent the Legislature from creating the single-payer system envisioned in the bill without voter approval.”
Those provisions include California’s byzantine, previously mentioned Proposition 98, which Dayen explains in more detail. To make single-payer funding possible Prop 98 would have to be suspended.
Self-appointed experts have countered that the state can suspend Prop 98 with a two-thirds vote of the legislature. This has been done twice in the past, during downturns in the economy. But the suspension can last for only a single year; it would have to be renewed annually to keep single payer going. More important, as the California Budget and Policy Center explains, after any suspension, “the state must increase Prop 98 funding over time to the level that it would have reached absent the suspension.”
So legislators would have to vote year after year to suspend Prop 98, but add more money back to cover it in subsequent years. That backfill would grow with every budget, and over time lawmakers would need to vote for ever-increasing giant tax hikes. If this didn’t return Republicans to power in Sacramento within a few years, some enterprising lawyer would sue the legislature for violating the spirit of Prop 98. Suspension is not politically, legally, or financially sustainable.
So, again, it sounds as if SB562 couldn’t be put into effect even if it became law, a point its supporters stubbornly refuse to concede. And the many unacknowledged roadblocks are also being overlooked by progressive organizations eager to make points about corporate sellouts in the Democratic Party. Certainly the Dems have more than their share of corporate sellouts, but IMO in this case making a scapegoat out of Anthony Rendon is just wrong. Dayen continues,
The California Courage Campaign pleaded with Democrats in an email blast to “fight for single payer today, not next year.” But Democrats can’t pass single payer today or this year; under state law, ballot measures only occur during statewide elections in even-numbered years. [UPDATE: in a separate message to supporters, the Courage Campaign wrote “it’s certainly true that the Healthy California Act needs more work before it can achieve all our goals” and was more circumspect about the road ahead.] Even the chair of the state Democratic Party, Eric Bauman, insisted that “SB562 must be given the chance to succeed,” even though it, um, can’t succeed.
The California Nurses Association, when not posting “stabbed in the back” imagery in reference to Rendon, called his decision “heartless,” “unconscionable,” and “disingenuous.” But there’s nothing more disingenuous in this debate than failing to level with people that SB562 cannot become law on its own.
Did I mention that Anthony Rendon has actually received death threats? And I’ve been an admirer of the California Nurses Association since they took on Arnold Schwarzenegger awhile back. But this is wrong. Everybody needs to chill about Anthony Rendon.
I know everybody’s tired of being told that we can’t have nice things now because pragmatic incremental whatever. But it’s also the case that sometimes things aren’t possible until paths are cleared for them. While, in theory, California’s economy ought to be able to support single payer, it’s not going to be possible until other laws — like Prop 98 — are changed first. And if you aren’t working on that, you aren’t serious about passing single payer.
I run into this a lot with lefties. Yesterday I ran into a rant that Bernie Sanders has his priorities wrong because he didn’t introduce a Medicare for All bill into the Senate this week. Would somebody explain to these puppies that a snowball has a better chance in hell than Medicare for All has in the current Congress? Because I don’t have the strength. And there’s been this little matter of stopping the passage of Trumpcare, which must have escaped their notice. That’s the priority.
I’m really tired of explaining why there can be no viable, national third party for progressives until we have significant voting and election reform that allows for proportional representation. I’ve tried and tried. They don’t listen to me. And like it or not, it’s way too soon to introduce a serious proposal to impeach Donald Trump into the House. This is not about whether or not he deserves it; it’s about the plain fact that such a proposal would go nowhere. The time may be ripe one of these days, but it isn’t now. And introducing unserious proposals now might make it harder to introduce a serious one later.
Bottom line, I fear that David Dayen is right on this, that SB562 was not a serious attempt to establish single payer in California, but instead was just legislative theater designed to aggrandize power within the progressive movement. Let’s stop doing this, people.
Devil’s in the details. We heard similar stories about abortive “single-payer” legislation in Vermont and Colorado, but if one looked at the details of those proposals neither was actually structured as single payer, regardless of how they were named.
I don’t know how much of this stuff is a massive two-headed kabuki dance, or internal power games, or some other kind of distraction. I’m skeptical about the feasibility of pursuing this on a state level anyway – the US isn’t Canada, and what happened to Medicaid Expansion should be an object lesson about piecemeal, incremental politics in the US. Heck, Medicare and Social Security still haven’t managed to achieve universal coverage, despite public mythology.
The one thing I remain pretty sure of is that Obama and the Dems could have passed national single-payer or a real public option during Obama’s first term. If they had wanted to.
“The one thing I remain pretty sure of is that Obama and the Dems could have passed national single-payer or a real public option during Obama’s first term. If they had wanted to.” I disagree, but that’s water under the bridge now.
“The one thing I remain pretty sure of is that Obama and the Dems could have passed national single-payer or a real public option during Obama’s first term. If they had wanted to.”
That kills me every time. Like this hasn’t been rehashed a million times. I’m assuming you’re joking, since Joe Lieberman will always be there athwart progress.
I’ve written about this bill at Common Dreams and was skeptical when it passed the Senate with placeholders for financing. Chairman Lara, author of the bill and who chairs the Appropriations Committee, didn’t bother to even adopt a committee report for financing, just some tepid analysis. Literally, that’s what his committee is supposed to do. It’s its reason for existing. He had complete discretion to examine financing options and adopt language to guide his colleagues, but did none of that.
KC — could we have a link to what you wrote at Common Dreams?
Maha – “I disagree, but that’s water under the bridge now.”
Oh, I wish it were just water under the bridge, but the same people and poltics are still controlling the Democratic party. Or do you disagree about that too? And I think the leadership’s actions at the time, both public and private, make it almost indisputable that they didn’t want to. I don’t believe in 12-dimensional chess as a political theory.
“but the same people and politics are still controlling the Democratic party. Or do you disagree about that too?” I don’t disagree, but in 2009 and 2010 the leadership wasn’t the only issue. The other issue was the rest of Congress. Jesus couldn’t have gotten single payer passed in that Congress.
Yeah, the Dems had a majority in both houses, but not a filibuster proof majority in the Senate. And many of the new Dems elected in 2008 and 2010 were Blue Dogs — nearly all gone now — who were very conservative and sided with the Republicans as often as not. So there was no way any thing as radical (to them) as single payer could have passed both houses. As far the Blue Dogs and most Republicans were concerned, the ACA was socialist enough. Don’t you remember how it kept getting watered down to get enough votes? And you think that Congress would have passed single payer? In what hallucination?
Losing the public option was a disappointment to me, too, but again, as I recall the biggest reason it wasn’t introduced is that it was understood it wasn’t going to get the votes, and the decision was made to save the fight for other issues. The public option could have been introduced later, at any time, but after the 2010 midterms that wasn’t gonna happen.
KC is right that Obama’s plan all along was the ACA. He and Hillary Clinton were running on nearly identical health care plans. There was no mandate for single payer whatsoever in 2009 and 2010. I don’t know how people got it in their heads that there was.
paintedjaguar, I just don’t understand your criticism and I see it a lot from the Left. Obama did not run on single payer, he ran on the ACA basically, with a public option. He spoke about it a lot in 2008 and never hid what he wanted to do. Ultimately, the bill he wanted passed the House (HR 3962), but Senator Lieberman (with silent support from a few conservative Democrats like Nelson) proudly and loudly killed the public option in the Senate as well as a Medicare buy-in option. None of this was hidden from anybody.
You can argue Obama should’ve yelled at Lieberman, gotten more LBJ so to speak, but LBJ had a 295 seat House majority and a 68 seat Senate majority to work with. Obama simply didn’t have the flexibility to push Senators around the way some like to imagine he could. He couldn’t afford to lose one Senator or the effort was dead.
There’s not much to say but lament the fact that as long as we have a system where money is a significant if not the main factor for politicians on either side of the aisle retaining their seats, then we will never be able to have common sense legislation designed totally for the benefit of the majority. And single payer is common sense, economically and socially.
I believe Obama and many other democrats wanted a public option with the ACA but monied interests opposing it won the day within the democratic party. Yes, the democrats had the majorities in both houses, but that still didn’t mean they had the votes. Interestingly republicans are learning the same lesson trying to undo Obamacare.
Given this, and Dayen’s article, we should all therefore just give up and wait. No. My wife has cancer. Many people throughout the state and the nation suffer from medical maladies and cannot get the treatment they need and have a human right to. I’ve long been a reader of Dayen’s articles, back to Firedoglake, but on this I think, while the point about Prop. 98 should not be ignored, that shouldn’t stop this bill. SB 562 is a strong push toward single payer for California and could be the fire that lights up the CA legislature and the Governor, himself a single payer supporter. As my Assemblymember Phil Ting stated in a recent letter to me, “…it declares that Californians have a right to health care and that the Legislature intends to enact such a system in the future.” While “the future” may be vague, without this legislation, it will forever remain vague. SB 562 will set the course for single payer in California, keep enthusiasm growing, and be the foundation for efforts to amend Prop 98.
Nonesuch — One more time — even if it’s passed, it would never go into effect. It sounds as if Prop 98 would have to be repealed first, and even then you’d have a hard time getting the necessary federal waivers.
Maha, I should have added “in comments” so as not to create a misimpression. However, I think you’ll see I am pretty familiar with the details of the bill. Here are a few:
https://commons.commondreams.org/t/the-cynical-opposition-of-some-democrats-to-universal-health-care/42874/21?u=kc2669
Off-topic: In respect for Maha’s Welsh roots, I thought she might find it mildly interesting that a Welsh rider won a stage on the Tour de France today. It was a first time for a Welsh rider in the history of the Tour. His name is Geraint Thomas. It was nice to get away from all the political nonsense of Trump.
Llongyfarchiadau i Geraint Thomas!
“The one thing I remain pretty sure of is that Obama and the Dems could have passed national single-payer or a real public option during Obama’s first term”
Really? Single Payer? They couldn’t even get a public option (Joe Lieberman) for Pete’s sake? I was no huge fan of Pelosi-Reid but I think the ACA was about the best they could get at the time, it wasn’t that long ago, I believe I remember quite clearly! I had hoped we would get single-payer one day but it won’t be until the large corporations that pull the strings in this country decide that the health care industry has priced them out of coverage for most employee’s. The big problem (among many) with Trump-care is that it eliminates the EHB’s (essential health benefits) for everyone including employer provided plans so instead of large corporations deciding health-care costs are too expensive and push for single payer now they will just offer their employees some shit plan that doesn’t cover anything, problem solved!
I’ve been living in California for 20 years. Prop 98 – which dictates how the government must spend funds, and which is an impediment to implementing universal health care in CA – is an example of what can go wrong when a state has an initiative and referendum process that lets citizens make laws. Initiative and Referendum was a progressive era idea (from the early 1900s) but we now have a state constitution with, I’m told 500 amendments.
This doesn’t even talk about what happens when moneyed interests use initiative and referendum to bypass the legislature to get their way enshrined in law. A good example is Prop 13, which capped and rolled back property taxes, which has had all sorts of pernicious effects throughout the state.
As for single payer – there’s somewhat of a parallel with citizen efforts to legalize marijuana (again through initiative and referendum). Many groups put forth propositions to legalize pot over the years, but the Democratic powers that be, including our governor, have generally withheld their support, because the propositions were ill-conceived, not thinking through all the consequences – much to the consternation of pot supporters. Eventually – after other states made pot legal (defying the federal prohibition) – a proposition came forth last year that seemed to be “the complete package” – everything well thought out and stipulated. This garnered enough support from the politicians, newspapers, and voters, and was voted in, with Donald Trump last year.
A similar thing is going to have to happen with single payer. It’s going to have to seriously address how single payer is going to really work, including the funding mechanism, before the powers that be get behind it. As a Californian, I’ve seen show bills before, and there’s usually a vocal constituency behind it, the prop dies, and supporters regroup and try again in a year or two.
A diagram of democrat’s single payer plan.
http://trulyfallacious.com/logic/logic-101/how-logic-works-formal-logic/attachment/then-a-miracle-occurs-logic
Universal health care – single payer – can not happen in the US free market until we regulate prices. The CA plan and ACA and every GOP plan leaves the medical system open for various quasi-monopolies to flourish at the Pharma level and Medical supplies & devices plus with for-profit hospitals and with insurance companies. There’s a bleepin’ reason health care for CA alone was budgeted at 200B.
The first damn thing we have to do as a nation is decide to regulate the medical market. I think all states have a PUC to set rates on water and electricity. The morality of this regulation is that people will die without these services and allowing private companies to gouge until people die would be obscene. We need to apply that thinking to health care because people are dying for lack of access – strictly because of cost.
Doug that cartoon is apt. Step one has to be some level of agreement on what we, the vast majority of citizens, want the system to acomplish with as you said a keen eye toward cost and cost control. As we used to say in a joking manner, you just can’t get to there from here. The formula may lack a miracle or more.
The following quote I find to be a much needed ray of truth. I hope some will think with us on this one.
“One reason for the gridlock, is that both politicians and voters don’t realize how little they understand. Whenever an issue is important enough for public debate, it is also complicated enough to be difficult to understand. Reading a newspaper article or two isn’t enough. Social issues have complex causes and unpredictable consequences. It takes a lot of expertise to really understand the implications of a position, and even expertise may not be enough.”
Sloman and Fernbach, The Knowledge Illusion: Why We Never Think Alone, 2017, p.16
Sometimes I just get too weary to bother responding to the same old crap. You guys are really bringing up Lieberman as an argument? As if he were some natural act-of-god disaster? Since I don’t have amnesia, I remember quite clearly how the Clinton/Obama New Dems went out of their way to keep Lieberman in a position of power when he was primaried. You could say similar things about other Blue Dogs.
As for the putative public option, I also remember how Obama threw that away in a secret deal before public negotiations even started. And how the Obama clique kept single-payer from even being discussed in legislative hearings, going so far as to arrest and eject single-payer advocates. So don’t bother trying to spin me the fairy tale that it was all the evil Republicans fault, or that Obama ever actually favored single-payer.