California lawmakers worked feverishly at the end of June to move
forward significant health reform legislation, including implementing
new Medicaid rules for the next five years, setting a framework for
establishing health insurance exchanges, and moving the state towards a
single-payer health care system.
State legislatures and city councils across the country are raising the
bar for how ambitious national health care reform should be, with many
coming out in favor of single-payer health coverage reform.
Single-payer system models
for reform are perhaps the "gold standard." Physicians for a National Health Plan has reported
that under a national single-payer system, individuals could expect to pay 2% of
their income into the system and employers about 7% of payroll. These
amounts are significantly less than what is currently spent.
Single-payer systems ensure
all residents have access to health care and significantly reduce
administrative and billing costs through a single portal for the
administration of coverage and payments to providers for
services. Importantly, single-payer systems combine all money
currently being spent in a relatively uncoordinated way into a single pool -
individual, employer and government expenses. There
are single-payer movements in numerous states, including Illinois, New
Mexico, Pennsylvania, Washington, Connecticut and California, which has twice passed
a single-payer bill only to be vetoed by the Governor.
While the political hill single-payer must climb is steep, all health care
reforms should be judged against the standard set by single payer
proposals - comprehensive coverage, maximum out-of-pocket expenses, administrative efficiency and simplicity, and
costs limited to a percentage of income. Many reforms in states are moving
in that direction and advocates and legislators are increasingly demanding
that half-measures be replaced with comprehensive proposals that meet this
The California legislature is again on the verge of
universal single-payer health
840, the California Universal Healthcare Act, sponsored
by State Senator Sheila
Kuehl, was recently approved by the State Senate and is now
before the Assembly, where it too is expected to pass.
legislation, which is often compared to a Medicare-for-all system, would
provide comprehensive and seamless health care for all
residents. Everyone - individuals, employers and government - would
share responsibility for funding the program. Importantly, consumers
would have complete freedom to choose their providers who would be paid
according to actuarially-sound reimbursement.