The Story Behind the Single-Payer Healthcare Mess in California

As Trump and the Republican Party look set to decimate the Affordable Healthcare Act at the national level, blue states have been focusing their attention on robust universal healthcare solutions. Nowhere has this focus been sharper than in California, where the state senate recently passed SB562, a universal healthcare bill.

But yesterday Assembly Speaker Anthony Rendon put the brakes on the bill, tabling it for a year rather than allowing it to move forward legislatively. The pushback has been fierce: Rendon’s move has been roundly condemned by everyone from Lieutenant Governor Gavin Newsom to Congressman Ro Khanna to newly elected California Democratic Party chairman Eric Bauman.

Rendon’s position isn’t totally indefensible, however. SB562 lacks many crucial details, not least of which is its funding mechanism. It has a hefty price tag–heavier than the bill’s proponents even expected–and the proposals to make it work have included a double tax increase that would probably kill the bill by losing support among the Assembly’s more moderate members (California law requires that any tax increase be supported by 2/3 of the legislature, which means Democrats can’t afford to lose almost any votes in their caucus.) Assemblymembers have a valid argument that it’s unfair of the Senate to expect them to hammer out the details within a shortened legislative window, and want to push the challenge back onto the senators. Rendon wants to shield his caucus from the votes, and is willing to take the slings and arrows of progressive activists to do so. Finally, as David Dayen noted on Twitter, voter-enacted Proposition 98 requires that a minimum percentage of the state budget be spent on education–which means that single-payer proponents would not only have to find a revenue increase for healthcare, but also for a percentage increase in education spending as well. That’s a very difficult hurdle, and almost certainly means that single-payer healthcare in California will have to be a popular referendum–in which case it could come from a signature-gathering process rather than from a potentially dangerous vote from the legislature.

But while all of this sounds reasonable, it misses a bigger context. It’s not as if Democratic wonks and liberal think tanks didn’t have time to think through all of these issues. It’s true that most of the heavy lifting on healthcare policy went into figuring out how to make the Affordable Care Act work. That was one of the key frustrations about the bill among single-payer proponents angry that defending its complexities and dependence on the private insurance market sucked all the oxygen out of the effort to come up with simpler solutions that look more like the rest of the developed world.

But at least since the election of Donald Trump, it has been clear that Republicans would really get their chance to severely hobble or destroy the Affordable Care Act. It has also been clear that workable universal programs in big blue states with economic leverage would be the next point of focus, particularly given the activist energy around the issue among progressives.

There is no excuse for the California Senate to have sent the Assembly such a hollow bill. But there is also no excuse for the Assembly not to have already done the hard work to figure out palatable details on the funding and transition structure. If the politics make it impossible for the Assembly to move forward on the bill as a united front, or if the constitutional restrictions mean that only a ballot initiative is truly feasible, then it’s incumbent on Democratic leaders to have made that clear in advance and to be providing the support for a signature-gathering process.

Instead, what we have is a mess: the healthcare wonks haven’t gotten their act together in a serious way, the Senate showboated with a hollow bill and expected the Assembly to clean up after them and take the truly difficult votes, the speaker is taking the heat to shield the conservative and cowardly members of his caucus, and a bunch of politicians with aspirations of statewide and national office are grandstanding against the speaker without providing any real solutions.

The best way out of this thicket is for Rendon to put SB562 back on the table, and put everyone to work on hammering out the details. If he lacks the votes in his caucus to pass it, or if Proposition 98 makes it impossible, or both, then he needs to be honest about that and work toward a successful ballot initiative. Tabling the bill for a year to put the onus back on the Senate just wastes time that desperate Californians and the nation at large cannot afford to lose.

David Atkins

David Atkins is a writer, activist and research professional living in Santa Barbara. He is a contributor to the Washington Monthly's Political Animal and president of The Pollux Group, a qualitative research firm.