California’s long-running debate over single-payer health care has entered a new phase, with University of California researchers concluding that a statewide system may be possible — but only after state leaders resolve a long list of major financial, legal and political questions.
A 181-page report prepared by researchers organized through the UCLA Center for Health Policy Research examines what California would need to decide before moving to a universal health care model financed through a unified system. Such a system could combine state and federal health care dollars with money now spent by employers and residents, and potentially require new taxes.
During a webinar Wednesday, the research team summarized its findings and responded to questions. On many of the most important details, however, the answer remained uncertain. The report does not prescribe one specific plan. Instead, it lays out the choices policymakers would face if they attempt to redesign how health care is paid for in California.
One of the biggest decisions would be whether the state should pursue a true single-payer model, in which California finances health care for all residents, or a more limited hybrid approach that preserves parts of the existing insurance system. Single-payer supporters often point to systems in the United Kingdom and parts of Western Europe as examples, though California’s health care landscape is far more fragmented.
State leaders would also have to decide whether California would continue paying the existing network of private and public health care providers or create a new state-run structure. Other questions include whether doctors and hospitals would be paid for each service they provide, or whether the state would keep some version of managed care, which now dominates both private insurance and public programs.
Federal funding would be another major hurdle. Medicare, Medi-Cal and other federal programs currently account for roughly half of health care spending in California. Any unified financing plan would likely depend on the federal government agreeing to redirect tens of billions of dollars to the state. The report also raises the issue of how such a system would treat undocumented immigrants, who are generally barred from federally financed health benefits.
The UC report suggests that a single-payer system could offer the greatest administrative efficiency by reducing billing complexity, paperwork and other costs associated with today’s mix of insurers and public programs. But researchers also noted that the same approach would likely be the most politically difficult to achieve.
For many progressives in California and across the country, single-payer health care has been a long-sought goal. Gov. Gavin Newsom embraced the idea during his 2018 campaign, saying at the time that he was tired of politicians claiming to support single-payer while arguing that it was too soon, too costly or someone else’s responsibility.
After taking office, Newsom shifted toward a more incremental strategy. He later described single-payer as an “aspirational” goal rather than a firm commitment, while his administration focused on expanding coverage through Medi-Cal and other programs.
Newsom did sign legislation in 2019 creating the Healthy California for All Commission to study the issue. At the time, he said the state needed input from experts in both the public and private sectors as California continued moving toward universal coverage.
The commission’s 2022 report supported the concept of unified financing but stopped short of calling specifically for a single-payer system. That work helped lead to the 2023 passage of Senate Bill 770, which directed further study by the University of California. The UC report, released in April, is the result of that effort.
In many ways, the report brings the debate back to where it began. When Newsom first promoted single-payer during his campaign, health policy experts already warned that transforming California’s enormous and costly health care system would be complicated. The new report reinforces that conclusion in extensive detail.
With Newsom nearing the end of his time as governor and widely viewed as a possible future presidential candidate, the question now is whether California’s pursuit of a unified health care financing system will continue — or remain largely an exercise in policy planning.
Original source: CalMatters
