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Senate Republicans’ failure to enact a health reform bill has created a big policy vacuum, and liberals in Congress and elsewhere are eager to fill it.
Their solution: Move to a “single-payer system.” That anodyne term actually means a government monopoly over the financing and delivery of health care.
Rep. John Conyers (D-Mich.) has already introduced a single-payer bill. His “Medicare for All” proposal has 117 cosponsors, more than half of all House Democrats. Sen. Bernie Sanders, the Vermont Independent, says he will soon introduce a “Medicare for All” bill in the Senate. It will doubtless be based on a plan he posted on his website last year.
State attempts to implement single-payer health systems have thus far been met with failure. But California seems poised to give it a try.
The Healthy California Act, a “single payer” bill that would displace existing private and employer-based coverage, has already passed the state Senate. Coverage would extend to illegal immigrants and—if the state gets the necessary federal waivers—persons enrolled in Medicare and Medicaid, regardless of their preferences in the matter.
To control costs, the proposal would create a politically appointed board (the Healthy California board) to set payment rates for doctors and other medical professionals. Working against these cost-cutting measures, however, are provisions to prohibit co-payments and deductibles, which today are routine in both Medicare and private insurance. Abolishing these consumer “skin-in-the-game” features on the front end guarantees higher overall program costs on the back end.
And costs are a huge problem. Analysts estimate the California plan will cost anywhere from $330 to $400 billion dollars annually—an amount larger than California’s entire state budget. (Total state spending amounts to $183 billion for FY 2017-2018.)
What if one of these experiments fails? Washington can limit the damage by making sure that federal taxpayers won’t have to bail out state failures. That way, if “Healthy California,” for example, crashes and burns, the fallout will at least be limited to that state’s taxpayers, doctors, and patients.