As part of what some are calling a “soft secession” from Republican-ruled Washington, California progressives are weighing various forms of resistance to Trump administration initiatives (notably in immigration enforcement), along with alternative policies the state might pursue on its own. The most striking in this latter category, considering how close Congress is right now to enacting a highly reactionary health-care bill, is a drive to create a state-based single-payer system.
Legislation to do just that has already passed the California Senate, and given the supermajorities Democrats possess in both state legislative chambers (not a luxury Democrats have in New York, another state that has made progress in the same direction), proponents of single-payer health care were looking to the Golden State for a breakthrough. But late last week House Speaker Anthony Rendon harshed their mellow by declaring the legislation dead for this year. Renton did not mince words:
In a statement, he mentions how the bill “was sent to the Assembly woefully incomplete,” namely that “it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.”
The bill that passed the California Senate, you see, did not address the rather significant detail of how single-payer would be financed. Since the official legislative estimate is that it would boost state health-care costs by $200 billion — which would more than double the state budget — that’s a pretty big omission.
But this rather obvious problem did not keep single-payer advocates from within and beyond the state from howling in fury at Rendon. Bernie Sanders said he was “extremely disappointed” at the Speaker’s action, and prophesied that, “If the great state of California has the courage to take on the greed of the insurance companies and the drug companies, the rest of the country will follow.”
RoseAnn DeMoro, leader of the California Nurses Association, the most avid backer of the California single-payer bill, was a bit blunter than Sanders:
Other critics accused Rendon of being a shill for private insurance companies and Pharma, not to mention the so-called “pro-business Democrats” in the legislature who are the bane of every California progressive’s existence.
The idea among single-payer advocates seems to be that California Democrats should insist on providing momentum for the proposal so long as it is formally possible. In truth, as Rendon’s statement suggested, there are various huge obstacles to the actual enactment of the single-payer bill that cannot be wished away. One is the reluctance of all Republicans and some Democrats in the legislature to vote for the new taxes virtually everyone concedes would be needed for finance single-payer (yes, they might well be more than offset for consumers by the disappearance of private-insurance costs, but that’s not something the state constitution with its supermajority requirement for new taxes would take into account). The second and least disputable problem that no amount of pressure or enthusiasm can fix is that folding all the existing federal health-care funding — including Obamacare, Medicaid, and Medicare — would require some sort of monstrous, unprecedented waiver from Washington (it is not even clear that the power exists to do that with Medicare). Does anyone think HHS Secretary Tom Price is going to do that so that godless liberal Californians can abolish private health insurance and provide free health coverage to everyone, including undocumented immigrants? No. It would take an actual, not a “soft,” secession to give California control over all the tax money for health care it sends to Washington.
So the dispute between Rendon and single-payer advocates really comes down to symbolism: How far should California Democrats take this idea before it is stopped cold by votes in the legislature or a mocking tweet from Donald Trump? Rendon clearly thinks the fiction this is happening has gone far enough. But he’s going to take some lumps for it.