After back-to-back vetoes, the departure of its champion of the past six years and now the prospect of a weakening economy, the flame for a single-payer health care system in California is diminished –Â but it hasn’t gone out.
The torch has been passed to a new legislative leader, and the movement to take health care away from the insurance industry and put it into government’s hands moves forward, beginning a second decade in California.
Although there’s little chance a single-payer plan could gain much traction in 2009, proponents say it’s important to keep trying.
“We will bring this issue back again and again until everyone in California has access to high-quality health care that puts people before insurance company profits,” said Democrat Mark Leno, newly elected state senator and single-payer’s new legislative leader.Â Â
Representing San Francisco, Marin and Sonoma counties, Leno takes the single payer reins from Santa Monica Democrat Sheila Kuehl who was termed out of office last month. Â He is the new principal author of the single-payer bill and plans to reintroduce it — hoping to retain the label SB 840 — early in the session, perhaps as early as next month. Leno will also chair the Senate Committee on Public Safety.Â Â
Slow, But Steady GrowthÂ
Starting in 1998 with a bill authored by Democrats Barbara Lee of Oakland and Diane Watson of Los Angeles, the single-payer campaign has grown steadily, if not swiftly, in California.
Under Kuehl’s leadership since 2002, the single-payer bill was co-authored last year by 49 of the 120 legislators in Sacramento and approved by almost twice that number. The Assembly and Senate passed the bill twice over the past three years. Republican Gov. Arnold Schwarzenegger vetoed the bill in 2008, just as he vetoed a version in 2006.
In 2006, Schwarzenegger issued a full-blown essay explaining his opposition. “Socialized medicine is not the solution to our state’s health care problems,” he said.
Last year, in a terse four-sentence announcement, the governor said, “According to the State Legislative Analyst’s Office, the bill is estimated to cost $210 billion in its first full year of implementation and cause annual shortfalls of $42 billion. I cannot support a bill that places an annual shortfall of over $40 billion to our state’s economy.”
Schwarzenegger remains in office through 2010 and fans of a single-payer health care system aren’t expecting him to change his mind but they do intend to keep the issue “alive and at the table, both in the national debate and in California,” Kuehl said.
“It’s important to keep the momentum going and to keep the bill alive for several reasons,” Kuehl said.
“The major reason is to improve the bill. Each time it comes back to the Legislature, it’s a better bill. Every time we present it to new groups they come up with suggestions — sometimes very good suggestionsÂ — that can be incorporated in some way.Â There were 30 to 40 small amendments just in the last session,” she said.
“The second reason to keep it going despite opposition from the governor is that it acts as a sort of rallying cry,” Kuehl said. “There are a lot of people very committed to seeing this kind of plan put in place, and even though it may not happen this year or next year, it’s important to keep the bill in motion as a tangible, living sign of that effort.”
California’s single-payer movement also helps keep the issue alive in the national debate, Kuehl said.
“The insurance industry doesn’t want single payer advocates at the table when President-elect Obama and Tom Daschle (Obama’s pick for HHS secretary) talk about what comes next,” Kuehl said. “One of the virtues of having 840 strong and public is that it provides a voice to bring the conversation back toward the middle. It offers an alternative to insurance mandates, which the insurance industry much prefers.”Â
Kuehl Now in National Single-Payer PlanÂ — Medicare
Kuehl, 67, is now a satisfied member of the country’s largest single-payer health systemÂ — Medicare.
“It works wonderfully,” Kuehl said. “As a participant in a single-payer system, I can say it’s a good way to provide care for the greatest number of people.”
Kuehl said she’d prefer a national version of California’s single-payer plan to a broadened Medicare system.
“With a national version of 840, every person would have to pay more in to the system than with Medicare. Many ofÂ us in Medicare are still working so we’re still paying into Medicare,” Kuehl said. “That participation helps and there would be more of that participation under 840.Â The more people you include the better.”
“Single payer is alive and well and a work in progress, getting input from lots of different stakeholders,” Kuehl said.
New Role for KuehlÂ
Kuehl is now a member of the state Integrated Waste Management Board, considered by many a sort of way-station for politicians between elected gigs.Â She has been mentioned as a possible candidate for Secretary of State.
Kuehl, who chaired the Senate’s Natural Resources Committee before chairing the Health Committee, was appointed to the Integrated Waste Management Board by outgoing Senate President Pro Tempore Don Perata (D-Oakland).
While her new duties take her in a different direction, Kuehl will not step entirely away from health care. “I’m here if needed,” Kuehl said. “I’ll be in Sacramento about half of every month and I still have lots of advice.”
Kuehl said that because of the state’s budget crisis, single-payer advocates should emphasize savings to the state.
“It’s very important to let people know that single payer is not a greater drain on the budget. It actually saves money. It can be part of economic recovery. That’s a leap that people need to be walked through. Not only can it bring savings in the safety net, single payer lifts all boats and that can be demonstrated,” Kuehl said.
Kuehl said she could “certainly see 840 becoming law in the next 10 years with a governor who is willing to roll up his sleeves and work out the details.”