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Single-payer healthcare is a radical and often controversial plan, yet is close to being enacted to varying degrees around the US. A single-payer system would, rather than having people pay for their medical care individually through insurance, would collect the funds which are necessary to provide healthcare and then source the healthcare from companies – leading to higher levels of efficiency and greater coverage. Even though a system like this goes against the sensibilities of certain groups and vested interests in America, two bills providing for a single-payer system in California have been passed, only to be rejected by then governor, Arnold Schwarzenegger. With a Democrat governor and Democrat majorities in the California Senate and House, surely the timing is perfect to enact this legislation?

medicare for all

A single-payer system would mean massive improvements on the current healthcare system. The first is that it would guarantee healthcare for everyone within the region in which it was enacted. This would provide for the 40% of Californians who currently cannot afford insurance. The result would be a dramatic increase in living standards and public health, in that those millions who currently cannot afford hospital bills, prescriptions and doctor's visits. In addition, a health system which includes all people would offer inpatient residential addiction services to a greater number of people. Drug addiction is a serious and in some areas a worsening problem – increasing coverage is one of the top ways to create a better rehabilitation system. The second is that, because healthcare would be purchased by a single-payer rather than hundreds of different insurance companies, costs would decrease significantly through a simplification in bureaucracy and process. Administration accounts for 20% of American healthcare costs, while this is only 2% in the Canadian single-payer system. Single-payer would, also, maintain competition and choice within provision – the state does not own any care systems as is the case within 'socialized healthcare'; rather it will contract care from private companies.

The Law That Should Have Been

The most fascinating aspect of the single-payer healthcare debate in California, and as such LA, is that during the governorship of Arnold Schwarzenegger, a bill which provided for single-payer healthcare actually passed through both houses of the legislature. They were, of course, dismissed by the governor. However, with a Democratic governor in place and Democrat majorities in both houses, the bill was not passed, rather it has disappeared. Campaign groups and elected representatives have a number of reasons why this plan hasn't already been enacted. One is that elected officials will be busy with the Affordable Care Act (ACA), and with responsibility for enacting the state responsibilities within this, drawing focus away from the single-payer proposals.

Michael Lighty, of the California Nurse Association, commented that he is not in favor of filing the bill again this year for tactical reasons. Specifically, he noted that the bill can only succeed with the governor's approval and, if it fails, it could harm the healthcare reform movement's other objectives, such as fully enacting the ACA. Specifically, fully achieving the ACA plans would create a suitable base from which to create a single-payer system within California. Lighty also observed that the insurance industry is likely to lobby for the government to add a repeal option to the state ballot, if the government passed single-payer legislation. If this were the case, he said, the electorate for the presidential election was the most supportive of these reforms, so that planning the legislative process around the 2016 poll may be the best path to creating a single-payer system.

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However, Vermont is currently creating the infrastructure for a single-payer healthcare system, for which the state legislature passed a bill in 2011. The Vermont system will run in parallel with the ACA – a fundamental fact, given that even the colossal Obamacare bill will still not provide universal coverage. The Vermont state project, while ambitious, is encountering financial difficulties – the people of LA and California will need to learn from these troubles when moving forward with their own single-payer bill.

Essentially, the timing is perfect for a Democrat-dominated legislature to pass a single-payer bill and to create a system which will provide high quality healthcare for all. However, this will carry a great deal of responsibility – seeing bills fall due to a Republican governor rested the blame with the other party; actually creating and maintaining a new healthcare system on the state level will be a long and demanding task. Nevertheless, getting the law passed seems very possible in the near future. This is true, given the right planning and liaison with the different arms of government and industry, and with – post importantly – the political will of the Democrats.

Julie Warner

Photo: Mike Chickey

Thursday, 4 July 2013