Opinion: Not sold on single-payer health care

By Joe Mathews

I’m so disappointed in myself.

I should be 100 percent supportive of establishing California’s own single-payer health system, which means that one entity—the government—pays for everyone’s healthcare. After all, the best Californians are for it.

California’s next governor, Gavin Newsom, has made single-payer central to his campaign. America’s next president, California U.S. Sen. Kamala Harris, is running on it.

So why do doubts keep springing to my diseased mind?

Maybe I resent beautiful, camera-ready people like Newsom and Harris. But good if homelier progressives—in unions, nonprofits, and the Democratic Party — also have made single-payer their No. 1 political litmus test. Any officeholder who doesn’t support it faces recall and Twitter bullying.

I confess that, in dark moments, I wonder whether single-payer is just a weapon for some political interests to use against their opponents. But how can I think such a thing when President-in-Waiting Harris recently assured us—as she co-sponsored legislation that protects you from health insurance by making it illegal for your employer to provide it—that single payer is “a nonpartisan issue”?

Upon hearing that, I asked myself: Haven’t Americans been fighting in partisan ways over healthcare for 100 years? But no, Harris is right: a century is a blip in the vastness of space-time.

Now, I admit that I can get crazy and wonder how practical single-payer is, and whether it might be wiser to build on the existing system. I also think about the one-third of all Californians, and half of children, on Medi-Cal, California’s version of Medicaid, which means the government pays for their care. Many of the people in this smaller version of single-payer struggle to get care because there aren’t enough doctors and institutions that will serve them.

Then I start thinking about money—money! I’m so ashamed! – and ask: Why doesn’t the single-payer legislation in California and in Congress explain how you pay for single-payer? Then I read these estimates that suggest that a single-payer healthcare system in California alone would cost $400 billion, which is two-and-a-half times the size of the state General Fund.

And that gives me an anxiety attack, since raising taxes requires a two-thirds vote of the Legislature, which can be hard to get. And then I worry—I’m not proud of this—about my kids’ schools. The two big pieces of the state budget are education and health care, so when you see a big run-up in spending on health, the schools get hit, and teachers get laid off and instruction time gets cut.

But then I get a hold of myself, and listen to Bernie Sanders (who like all Vermonters knows California deeply), and I stop worrying.

Because California’s schools already do remarkably well with some of the lowest state funding levels in the country. So why would it matter if they’re cut further? Since everyone will be so much healthier under single-payer, the teachers will be able to teach more kids in less time, and the children will learn faster!

And, after listening to single-payer advocates, I’m sure that this single-payer healthcare will pay for itself; in fact, it will save money, because all the money we spend on insurance and pharmaceuticals will just be replaced by new taxes, and the resulting efficiencies will create some savings. (Don’t sweat the details). And while there may be startup costs, this is California, with an economy the size of France’s. We’ve got plenty of money. If the taxes don’t come through at first, we’ll have a Kickstarter campaign. Or crowdsource it. Or make Mexico pay for it.

Since having those realizations, I’ve been totally behind single-payer—with the exception of one bad bender of doubts. My trigger for that episode was the housing crisis.

I was reading a UCLA report about how far behind we are in meeting Californians’ needs for housing they can afford. And then I saw the news that, spurred by rising homelessness, Los Angeles and San Diego counties now have Hepatitis outbreaks that constitute public emergencies.

So I couldn’t stop my mind from thinking: How can these fancy people running our state be talking about some pie-in-the-sky single-payer when they’re failing to provide Californians with the most basic piece of the healthy life—shelter?

But then I realized I was stuck in the past. Just because our systems for education and housing haven’t produced enough of either doesn’t mean that single-payer healthcare won’t produce enough healthcare.

Then it hit me: All my doubts about single-payer are a form of illness, and that illness is itself the best possible argument for single-payer.

Because, clearly, I’m sick in the head. And if there were a cure, I couldn’t afford it.

So bring on single-payer. It will fix me, and good.

Joe Mathews writes the Connecting California column for Zócalo Public Square.