California's single-payer health care boondoggle is back and worse than ever

Karl Marx could have been forecasting the future of California when he said that history repeats itself – first as tragedy, then as farce.

The tragedy is a state budget of $225.9 billion this year, with a budget deficit equivalent to nearly one-third of that figure – $73 billion, according to the latest estimate from the state Legislative Analyst's Office. 

The farce is California state Assemblyman Ash Kalra, a Democrat, re-introducing legislation to ban private health insurance and force all Californians into a single, publicly run health plan – at a cost estimated at $391 billion a year the last time he brought it forward, in 2021.

Supporters of single-payer health care march to the Capitol, April 26, 2017, in Sacramento, California. (AP Photo/Rich Pedroncelli, File)

Spoiler alert: It hasn't gotten any cheaper since then.

SINGLE-PAYER HEALTH CARE: WHAT IS IT?

This fixation on single-payer health care is not just unrealistic. It's sadistic, given that single-payer forces people to wait in long lines for subpar treatment, in large part because low government payments result in persistent shortages of doctors.

Look at Britain's National Health Service. British junior doctors have gone on strike 10 times since March 2023. They're paid a pittance to keep a lid on costs. 

The strikes have only delayed treatments and made waiting times worse. Since December 2022, more than 1.2 million appointments have been canceled thanks to a severe shortage of doctors, nurses and paramedics.

Roughly 6.3 million people were on waiting lists for more than 7.6 million treatments in England as of the end of December. That's more than 10% of the population. Ghastly stories abound of patients waiting years for critical treatment, or stuffed in hospital hallways until a bed frees up, or watching their fellow patients die in waiting rooms.

HEALTH CARE PRICE TRANSPARENCY COULD SAVE AMERICANS $1T ANNUALLY

To escape these horrors, around one in eight Brits pay for private health care outside the public NHS. 

Our neighbors in Canada face similar woes under their single-payer health care system. According to research from the Fraser Institute, a Vancouver think tank, Canadians face a median wait of nearly 28 weeks for care from a specialist following referral by a general practitioner. 

In Canada, private insurance is illegal – unlike in the United Kingdom. So Canadians must leave the country if they want timelier care. A 2019 report from SecondStreet.org, a Canadian think tank, found that Canadians made more than 200,000 trips abroad to seek medical care in 2017.

Are Californians ready to wait seven months for crucial treatments? Or will they leave the state and pay out of pocket for care more quickly?

MONTHLY HEALTH INSURANCE PREMIUMS FOR NEARLY 2 MILLION CALIFORNIANS EXPECTED TO RISE NEXT YEAR

Kalra calls his latest bid for single-payer – officially dubbed AB 2200, the California Guaranteed Health Care for All Act – an improvement on his previous efforts. It's hard to see how. 

He proposes to pass the bill, then ask the federal government for a waiver to divert all the money it delivers to the state for the likes of Medicare and Medicaid into a new "CalCare" health plan. 

There's no plan for how to come up with the rest of the money needed to pay for it. But given the estimated cost of previous single-payer plans, it could require doubling the state's tax take.

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This is, to be blunt, unlikely. The last time single-payer advocates came knocking in Sacramento, they were counting on Gov. Gavin Newsom going along with them to fulfill campaign promises. Staring down a record budget deficit, the governor is highly unlikely to back a wholesale single-payer system. 

In fact, it's unclear how he'll come up with the $2.6 billion a year he's committed for state-funded coverage for illegal immigrants through Medi-Cal, the state's Medicaid program. 

Even many California Democrats recognize that single-payer is a pipe dream. "I'm just stating the obvious, that's always been the concern about single-payer -- the cost," Assembly Speaker Robert Rivas said last month. 

Fiscal reality may be the death knell for single-payer in California this year. But it's safe to assume that the state's progressives – not to mention the California Nurses Association, which has been a driving force behind AB 2200 and its predecessors – will resurrect the idea again and again. 

Patients should take note of how government-run systems in other countries delay and deny care – and make clear that they won't stand for such tragedies or farces here.

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Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All" (Encounter 2020). Follow her on X, formerly Twitter, @sallypipes.