Medicare expansion would make socialized health insurance inevitable

MedizinSeveral lawmakers want to pull more people into Medicare. This would hurt anyone with private insurance, and it would inevitably lead to single-payer, government funded healthcare, which would deprive people of any choice over their healthcare.

Sen. Debbie Stabenow, D-Mich., recently introduced S.470, a bill that would let any citizen or permanent resident between the ages of 50 and 64 buy into Medicare. It received broad support from her Democratic colleagues. Numerous 2020 presidential hopefuls, including Sens. Cory Booker, D-N.J., Kamala Harris, D-Calif., and Kirsten Gillibrand, D-N.Y., have co-sponsored the bill.

Lawmakers in the House of Representatives want to go even further. In December, Reps. Rosa DeLauro, D-Conn., and Jan Schakowsky, D-Ill., introduced a plan called Medicare for America. It would allow anyone in America, regardless of age, to buy into an expanded Medicare system that covers prescription drugs along with dental, vision, and hearing benefits. Those currently covered by Medicare, Medicaid, and CHIP would be shunted onto the new plan, as would anyone who buys policies on the individual market.

These proposals would cause prices for private plans to spike.

Medicare underpays for the services its beneficiaries receive. In 2017, hospitals only received 87 cents per dollar spent treating Medicare patients. That means Medicare underpaid hospitals by $53.9 billion.

As more patients shift to Medicare, providers will have to charge private insurers more to make up the difference. That will result in higher premiums for the privately insured.

In other words, Uncle Sam would charge people twice for Medicare, once through the IRS and again at the doctor’s office.

Gradually, people on private plans would get sick of high prices and start moving to Medicare. As people abandoned private plans, insurers would start going out of business. Before long, it would be easy to turn Medicare into an obligatory, single-payer program. That would leave patients with no insurance options.

Patients wouldn’t like that. More than seven in 10 folks with employer-sponsored health insurance are satisfied with their plans. Nearly 60 percent of people say they oppose Medicare for All if it comes at the expense of private insurance, according to a recent Kaiser Family Foundation poll.

Expanding Medicare is a bad deal. Lawmakers should abandon the idea.

This article was originally published by the Pacific Research Institute.

Expect More Surcharges as Businesses Cope with High California Costs

Business costs“Stopped by a Pizza Hut to bring some food in last night and was met with this beauty,” an L.A. Daily News reader emailed under the subject line, “Soon to be all over California?”

Two photos were attached. One showed a bright red sign displayed prominently on the restaurant counter. Printed in bold type was this message: “Service Fee Disclosure – This location includes a service fee on all transactions. The service fee partially offsets the increased cost of operations in the State of California.”

The second photo showed a receipt with a 3.5 percent “service fee” below the subtotal and above the sales tax, and in extra-large letters, “SVC fee partially offsets the rising costs in CA.”

But it’s not “soon to be” all over California. It’s already all over California.

Ground zero seems to be San Francisco in early 2008, when a local law known as the Health Care Security Ordinance went into effect. The law requires any business in San Francisco that has 20 or more employees to set aside funds for workers’ health care.

Many restaurants decided to add an extra charge to customers’ checks instead of raising menu prices. Initially, some restaurants labeled the fee, “Healthy S.F. Surcharge.” Then in 2011 the Board of Supervisors amended the ordinance to require that any restaurant owner adding a “health” or “healthy” surcharge had to spend 100 percent of the money collected on health care. The city attorney investigated dozens of restaurants, leading to a costly settlement in 2013. The surcharges didn’t go away, but the name changed. Today they’re generally called “SF Mandates.”

This year, San Francisco’s Health Care Security Ordinance will cost employers $1.95 for each hour that each worker is paid, unless the employer has 100 or more employees, in which case the rate is $2.93.

The restaurant business is labor-intensive, and the cost of labor in California has been going up.

In 2015, the state mandated that employers give their workers three days a year of paid leave. In the Northern California town of Redding, Che Stedman, the co-owner and executive chef of Moonstone Bistro, began adding a 3 percent charge to customers’ checks to help cover the cost. “That is 24 hours of full paid leave,” he said, “so now every single employee that we have, we have to make sure that we have that money banked.”

Then in March 2016, on the Saturday before Easter, Gov. Jerry Brown cut a backroom deal with labor union leaders and state lawmakers to ratchet up the minimum wage in California to $15 an hour by 2023 for smaller employers, and by 2022 for larger ones. The Assembly Appropriations Committee passed the measure in 90 minutes and within 24 hours it was on the governor’s desk for his signature.

The California Restaurant Association was steaming like a Chinese dumpling but they couldn’t do a thing about it.

Or could they?

“Due to a myriad of legislative and court decisions, some restaurants in California have elected to add a surcharge to their receipts to defray increased costs incurred over the last several years,” begins an article on the association’s website titled, “Understanding and Guidance on Surcharges.” The tone is matter-of-fact. “The increased costs of operating a restaurant can be attributed to minimum wage increases, health care, paid sick leave, restrictive scheduling, cost of food and supplies and increased pay equity between traditionally tipped employees and heart of the house employees.”

The article offers advice on how to calculate taxes correctly and how to avoid getting sued by a city attorney, such as the one in San Diego who filed a slew of cases in 2017 charging some surcharging restaurants with false advertising and consumer fraud.

Last November, a San Diego Superior Court judge ruled in one of these cases that “the surcharge is not unlawful as a matter of law.” Similar rulings followed in similar cases.

Still, the California Restaurant Association recommends that restaurant owners minimize the risk of lawsuits by clearly disclosing the existence of a surcharge on a prominent sign or posting, large and conspicuous enough so that the sign is “likely to be read and understood by an ordinary individual under customary conditions of use and purchase.”

To avoid the problem that San Francisco restaurant owners had with the “health” surcharge, the association recommends keeping the reason for the surcharge as broad as possible, suggesting as one example, “to defray the increased cost of operations.”

“In the State of California,” added the owner of the Pizza Hut in Los Angeles, a city in which businesses also have to deal with a gross receipts tax and a trash monopoly franchise system that has sharply raised the cost of sanitation service.

Stephen Zolezzi, CEO of the Food and Beverage Association of San Diego, said in 2018 that surcharges allow the restaurant industry to send a message.

“Yes, it’s a political statement,” he said. “We’re trying to show people the consequences of legislation that adds to the cost of doing business.”

So the next time you see a “rising costs in CA” service fee on your restaurant receipt, don’t complain to the management. Go online to findyourrep.legislature.ca.gov and get the names and phone numbers of your state Assembly and Senate representatives. Chew them out for passing laws that are running up your bills.

Susan Shelley is a columnist and member of the editorial board of the Southern California News Group, and the author of the book, “How Trump Won.”

Originally published in the Los Angeles Daily News 

Can California Afford to Provide Universal Health Care Coverage?

Healthcare costsPerhaps no issue looms larger on both the state and national political stage than the question of universal health care coverage.

U.S. Presidential hopeful Kamala Harris (D) sent a shockwave through the national health care debate on Monday Jan. 28th by nonchalantly stating that she would eliminate private insurers as a necessary part of implementing “Medicare-for-all,” according to a CNN report.

Due to a firestorm of attention, most of it negative, the next day the Harris campaign walked back the previous day’s remarks in large part by stating that the candidate would also be open to more moderate health reform plans, which would preserve the private industry, according to the CNN report.

Newly elected California Governor Gavin Newsom (D) campaigned on the issue of single-payer health care and on his very first day in office unveiled a comprehensive package of reform proposals aimed at expanding state health care coverage subsidies and lowering its costs, which includes extending Medi-Cal to undocumented immigrants, according to a report by the LA Times.

In an interview, Gov. Newsom told the LA Times “These are not just symbolic gestures…We’re hoping to ignite a new conversation. It’s a moral imperative, not just economic,” states the LA Time report.

But as many experts, including Gov. Newsom, have pointed out, big systemic reform to the system, such as a move to a single-payer health system, would require the unlikely support of the Trump Administration.

Newsom has done a good job of tempering expectations for single-payer health care and his proposed coverage expansions and prescription cost controls demonstrate to the his supporters and the public that he is serious about expanding coverage as well containing costs.

But the 800-pound guerilla in the universal health care conversation is where will all the money come from to provide guaranteed government financed coverage to every Californian and everyone who likely to come to California once universal health care is guaranteed by the state?

“Where do you get the extra money? This is the whole question…I don’t even get it…how do you do that?,” said former California Governor Jerry Brown (D) following a universal healthcare discussion in Washington, D.C. in a 2017 interview with the LA Times.

At the time, Gov. Brown pointed out that the overall cost of medical care in California is equal to 18% of the state’s gross domestic product, which would be about $450 billion.

“You take a problem and say I’m going to solve it by something that’s an even bigger problem, which makes no sense,” then Governor Brown said at the time, according to the LA Times report.

Gov. Newsom developed some questionable rhetoric during the 2018 campaign, where he said that the State of California cannot afford not to move to a single-payer system because health care has become such a big expense in the state.

It appears that one of the major points of disagreement between former Gov. Brown and now Governor Gavin Newsom is the question of whether the State of California can afford to move to a universal health care system, specifically a single-payer system?

More recently, other high-profile liberal Democrats have come out against single-payer health care with former Mayor of New York City and billionaire Michael Bloomberg stating that Medicare-for-all “would bankrupt us for a very long time,” according to a CNN report.

“I think we could never afford that,” Bloomberg said, addressing pin factory employees in New Hampshire. “We are talking about trillions of dollars.”

“I think you could have Medicare-for-all people who are uncovered, but that’s a smaller group,” Bloomberg said.

“But to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time,” said Bloomberg according to the CNN report, which noted that Bloomberg made the comments in response to Sen. Kamala Harris calling for an end to the private health care market.

So what does all this mean for the current universal health care debate in California?

It means that California Democrats might want to heed the advice of two of the county’s most prominent liberal Democrats—former Gov. Jerry Brown and Michael Bloomberg—and proceed with great caution regarding the feasibility of California going it alone on universal health care.

There is no question that the state could choose to enact a single-payer or Obamacare-type universal health care system, but the million dollar question, or trillion dollar question rather in this case, is would such a system work and be fiscally sustainable over the long-term?

As a long-time analyst of fiscal issues in California, I believe that former Gov. Jerry Brown and Michael Bloomberg are correct to point out the major challenges and risks of moving to a universal health care system—both at the state level and the federal level.

David Kersten is an independent political consultant who lives in the Bay Area. Kersten is also an adjunct professor of public budgeting at the University of San Francisco.

Newsom makes health care the centerpiece of California’s resistance to Trump

MedizinFor California under Gov. Gavin Newsom, the resistance to President Donald Trump is about health care.

Much as his predecessor Jerry Brown made climate change the state’s big challenge to Trump, Newsom has embarked on a health agenda that includes extending care to undocumented adults and direct government negotiation of drug prices.

Unlike the other 2020 candidates pushing universal health care, Newsom’s policies aren’t just theoretical Washington talk, so there’s much more at risk. If his innovations in expanding Obamacare, extending Medicaid to undocumented immigrants — itself a jab at Trump’s hard-line immigration policies — and negotiating lower drug prices work, he could emerge as a hero of the Democratic Party. His policies could be templates for candidates pushing ahead on universal health care — an aspiration shared by Democrats even if they are still divided on what specific policies to pursue and how quickly to pursue them. …

Click here to read the full article from Politico

Spending Plans Will Run Up Against Fiscal Reality

Gavin NewsomGavin Newsom was recently inaugurated as California’s 40th governor, taking over a general-fund budget that is flush with cash and a state government that is in remarkably good shape — at least superficially — from a fiscal perspective. For all his flaws, outgoing Gov. Jerry Brown left Newsom with a $15 billion surplus and a rainy day fund that is nearly full. As an added plus, the economy that is humming along even though an erratic stock market points to storm clouds on the horizon.

The big question is whether Newsom will heed Brown’s advice and govern as if there’s always a recession around the corner — or ignore the former governor’s warnings about Democratic lawmakers who always say “yes” to any “harebrained” spending scheme. Unfortunately, based on Newsom’s inaugural words, initial budget and many of his early high-level administrative appointments, the safe money is on the latter. Newsom wants to spend big.

One need not read between the lines in Newsom’s introductory words. He spelled it out clearly. Newsom pointed to Brown’s inaugural address, which quoted from the Sermon on the Mount. There was the foolish man who built a house on sand and the wise man who built it on rock. “For eight years, California has built a foundation of rock,” Newsom said. “Our job now is not to rest on that foundation. It is to build our house upon it.”

So now that the state is on solid financial footing, the new governor envisions a rapid expansion of government social programs. “We will support parents so they can give their kids the love and care they need, especially in those critical early years when so much development occurs,” Newsom said. That speaks to the $1.8 billion in early childhood programs that the new governor is touting. The term “we,” of course, refers to California’s taxpayers.

“We will launch a Marshall Plan for affordable housing and lift up the fight against homelessness from a local matter to a state-wide mission,” he added. The term “Marshall Plan” is not subtle. That was the American financial assistance program to help Western Europe rebuild after the devastation of World War II, at a cost of $100 billion in current dollars.

Continuing the metaphor of California as a home, Newsom added that “In our home, every person should have access to quality, affordable health care.” He has long advocated for some type of universal healthcare coverage (although not necessarily the single-payer system that failed to make it through the Legislature in 2017), and some of his most noteworthy aides have a background in promoting government healthcare programs.

“Everyone in California should have a good job with fair pay,” he said. “Every child should have a great school and a teacher who is supported and respected. Every young person should be able to go to college without crushing debt or to get the training they need to compete and succeed. And every senior should be able to retire with security and live at home with dignity.” Those are vague, feel-good ideas that would garner few objections. But his ideas for implementing them, such as his bidget plan for free community college, will come with a hefty price tag.

There will be plenty of time to dissect the specific policy proposals that will move forward as the legislative session gets under way. For instance, the community college idea is a particularly bad one. California community colleges already are inexpensive. Making the second year of tuition “free” (the first year already is free for first-time California students) will only clog up the classrooms with free riders, thus making it tougher for those students who are serious about getting an education to get classes and improve their job prospects.

However, the main purpose of this article is to provide a warning amid the exuberance of a new gubernatorial administration. Basically, that financial foundation might be built less on rock and more on sand than many of us would like to believe.

There’s no complaining about the size of the budget surplus and rainy day fund, but there’s more to a budget than those items. As a comprehensive new California Policy Center report from Ed Ring and Marc Joffe points out, “We estimate that California’s total state and local government debt as of 6/30/2017 totaled just over $1.5 trillion. That total includes all outstanding bonds, loans, and other long-term liabilities, along with the officially reported unfunded liability for other post-employment benefits (primarily retiree healthcare), as well as unfunded pension liabilities.” That’s a 15-percent increase from two years ago—and a number that equals 54 percent of the gross state product.

The Brown administration had done little to deal with the unfunded liabilities. Its one major pension reform law, the Public Employees’ Pension Reform Act, was exceedingly modest. In the waning days of his administration, Brown’s attorneys argued before the state Supreme Court for changes in the “California Rule,” which restricts the ability of governments to reduce pension benefits going forward. That’s still unresolved and Newsom already has made clear his opposition to changes in pensions—and one of his top aides comes out of the California Labor Federation.

Bottom line: Just because the general-fund budget is in good shape does not mean that California’s overall fiscal picture is all that bright. A responsible new administration would attempt to fix those problems, which are crowding out public services at the local and state level, before engaging in a spending spree that will add to the state burden. Newsom’s early budget hits $209 billion overall and includes a grabbag of new programs, although he does send money to pay off some pension debt and is bolstering the rainy day fund.

The outgoing governor increased taxes early and often. It’s unwise to add new burdens on taxpayers, especially given that economic boom times always are followed by a bust and many Californians continue to flee the state’s high tax burden. Newsom already is proposing new fees on water and 911 service.

California’s most notorious public-policy disasters have come, counter-intuitively, during the best fiscal times, when revenues were swelling and budgets were flush with cash. The best example came in 1999, when Gov. Gray Davis signed a law that caused a pension-hiking frenzy and led directly to the state’s debt crisis. The stock market was riding high and the California Public Employees’ Retirement System (CalPERS) promised that increasing pensions by 50 percent retroactively wouldn’t cost taxpayers a dime because market returns would cover the costs.

It didn’t cost a dime, but cost billions of dollars annually in general-fund payments and added hundreds of billions of dollars in taxpayer-backed liabilities. The biggest danger to California is now a governor who believes that the state is in such great financial shape that he can start spending with wild abandon. He will not be restrained by the Legislature, which now has strong Democratic super-majorities that are itching to spend money. We don’t want to wish for an economic downturn, a stock-market crash or another busted housing bubble, but that appears to be the only hope right now to derail the coming spending train.

This column was first published by the California Policy Center.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

Federal Oversight of California Prison Health Care Continues

Photo credit: Michael Coghlan via Flickr

Photo credit: Michael Coghlan via Flickr

Since 2006, the federal courts have had a formal oversight role with California’s prison health care system – a result of a long history of poor care provided to inmates. A new scandal makes it seem highly unlikely that the state will regain full control of its prisons any time soon.

Sacramento-based U.S. District Judge Kimberly Mueller – who is the present overseer of the system – has ordered an independent investigation into allegations that the state systematically lied about the care being provided to the 30,000-plus inmates with significant mental health issues.

The allegations were detailed in a 161-page report by Dr. Michael Golding, chief psychiatrist for the state Department of Corrections and Rehabilitation. While officials claim that mental health treatment in state prisons is much better than it used to be, Golding wrote in a 161-page whistle-blower report that fewer than half of inmates were seen within the strict time limits set after past lawsuits, and that some inmates didn’t receive treatment for months.

Golding wrote that one female inmate who wasn’t provided needed medication yanked out one of her eyeballs and then ate it.

State denies lying about mental health treatments

The state has vigorously challenged Golding’s claims since he leaked his report in October. In court filings, lawyers for the state say he often jumped to conclusions based on vague evidence. “Dr. Golding’s implication that patients languish for many months without a psychiatric contact is inaccurate,” said one document.

State lawyers also strongly opposed Mueller’s decision to name former U.S. Attorney Charles Stevens to investigate the allegations, saying it overstepped her authority and that existing prison monitors could handle a probe. They also blasted the judge’s requirement that the state pay for the investigation.

But Mueller said in appointing Stevens, she was fulfilling her responsibility in her oversight role. “The court has not merely the authority, but also the duty, to protect the integrity of the judicial process,” Mueller wrote.

She also ordered prison officials not to retaliate against Golding and other prison staffers who helped him gather information for his report.

Mueller directed Stevens to report back to her by mid-April on his findings. While a U.S. attorney in the Clinton administration, Mueller won a reputation as a hard-charging prosecutor for his role in convicting the Unabomber, Theodore John Kaczynski, and in several political corruption cases.

This isn’t the first time that the Brown administration has accused Mueller of going beyond what is allowed in her prison oversight role. But the 9th U.S. Circuit Court of Appeals in November rejected the state’s argument that she didn’t have the authority to fine the state $1,000 a day if mentally ill inmates didn’t get timely treatment.

Mueller may hold off imposing such fines until Stevens delivers his report on the new allegations.

Three prison psychiatrists have alleged wrongdoing

Two other Corrections Department psychiatrists have made allegations about poor mental health care that were similar to Golding’s, according to a Sacramento Bee report last month. Dr. Melanie Gonzalez still works for the department and also received a protection order on her behalf from Mueller. Dr. Karuna Anand says she was fired by the agency last year after complaining about how bad conditions were at the state prison in Stockton. She is pursuing a civil lawsuit against the state.

The federal oversight of state prisons was ordered in 2006 by U.S. District Judge Thelton Henderson. The ruling resulted from a class-action lawsuit filed in 2001 against the state over health care in California prisons.

This article was originally published by CalWatchdog.com

Gavin Newsom and Impending Tax Increases

Gavin newsomIn his successful campaign for governor Gavin Newsom promised to advance a number of programs like universal pre-school, health care for all and education that will be costly. Where does he get the money while also considering how to reform the state’s tax system?

Shortly after the election, fellow Democrats, including Assembly Speaker Anthony Rendon are also talking tax increases.

If the Democrats secure the two-thirds supermajority in the legislature required to raise taxes—which appears likely at this time—the foundation will be in place for tax increases.

In a state notable for decades as the home of tax resisters, there are signs that voters may not object. In the last few statewide elections voters have raised income and sales taxes and rejected repeal of gas taxes and extending property tax breaks.

On the local level, voters continually vote to raise numerous taxes.

How many more tax increases are in the future and where will Newsom draw the line?

Is Newsom planning on confronting Proposition 13 when the split roll appears on the 2020 ballot—a position his predecessor, Jerry Brown, avoided?

Newsom is already listening to Senator Bob Hertzberg, re-elected Tuesday, to consider an overhaul of the entire tax system that would include some form of service taxes. If Newsom wants to spend political capital on such an ambitious effort it would likely come soon.

However, Newsom has said such an effort would take time. Look for another tax reform committee to be formed—which would be the fourth such committee over the last 20 years.

Or the incoming governor could rely on Hertzberg’s connection with Nicolas Berggreun’s Think Long Committee to do the heavy lifting on formulating a tax reform plan….or cut an overall tax package deal in the legislature that could include a move on commercial property taxes.

Another question: Will tax reform venture into the difficult area of spending issues, particularly the cost of pensions?

And what happens if the economy turns sour? Are all bets off on reform…or is that the time to go for it considering California’s current tax structure was birthed in the gloom of the Great Depression.

Look for early signs on tax questions in the budget and official announcements from the governor’s office.

This article was originally published by Fox and Hounds Daily

CA Spent $4 billion on Medi-Cal for People Not Eligible

MedizinCalifornia spent $4 billion on Medi-Cal coverage between 2014 and 2017 for people who may not have been eligible for the government-funded health plan, according to a state audit released Tuesday.

Medi-Cal provides health coverage to 13.1 million Californians, approximately one-third of the state’s population. To qualify, a single adult must make less than $16,754 annually.

County workers typically determine whether someone is eligible for health coverage under Medi-Cal, then send that information to the state. But the records don’t always match up.

The audit found 453,000 beneficiaries who were marked as eligible in the state’s system, but not in the counties’ — indicating that they may not have actually been eligible for Medi-Cal. These beneficiaries may have died, moved or begun making more money and no longer qualified for Medi-Cal. …

Click here to read the full article from the Los Angeles Times

California’s Single-Payer Health Care Plan Would Be Costly and Risky

MedizinSingle-payer health care is e a major issue in California’s 2018 gubernatorial election. Democratic candidate Gavin Newsom has strongly endorsed the idea, while Republican candidate John Cox is opposed. Last year, a single-payer bill, SB 562: The Healthy California Act, passed the state Senate but was placed on hold in the Assembly.

SB 562 would replace the current health care system with a state program under which all provider claims are paid centrally with no network restrictions, deductibles, co-pays, or other limitations. One governing body would replace the current array of public and private insurers. Medicare, Medi-Cal, and the Children’s Health Insurance Program (CHIP) would be integrated into the new system.

Proponents of single-payer primarily tout its ability to move the state towards universal coverage. However, California is already fairly close to achieving universal coverage. The June 2017 CDC report states that only 6.8 percent of Californians are uninsured. The other 93.2 percent already have private insurance, Medi-Cal, or gained insurance through Covered California during the Affordable Care Act (ACA) expansion.

Creating a single-payer health care system would be enormously costly, time-consuming, and difficult from a political and implementation standpoint. If achieving universal coverage is the primary goal, existing insurance schemes and government programs could be expanded to cover the uninsured instead. If Medi-Cal coverage is considered insufficient, it could be enhanced without impacting other categories of insurance.

A major argument from proponents of single-payer is the claim that it saves money by eliminating profits and administrative overhead — money that is going to insurance providers. Relative to all health care costs, these amounts are quite small. Most California residents already have coverage either through the government (Medi-Cal or Medicare) or a non-profit provider (Kaiser Permanente or Blue Shield), so profits only enter into the equation for a minority of Californians. Second, SB 562 would remove incentives to control costs, eliminating managed care. As a result, provider charges would probably increase substantially, overwhelming any savings from the elimination of middlemen.

Kaiser Permanente, the nation’s largest non-profit health plan and the insurer for many Californians, is known for its high quality of care and cost-conscious decision-making. A single-payer system would eliminate managed care organizations, and with them, the years of efficiency gains made to eliminate wasteful spending and improve quality. A statement by Kaiser’s CEO last year emphasized the difference between universal coverage and single-payer, mentioning his hesitations with single payer’s outdated fee-for-service model.

Perhaps the most daunting challenge of a single-payer system is the price tag. Analyses estimate that implementing a single-payer system would cost California between $330 billion and $400 billion per year, and there are reasons to believe that these estimates are too low. To put the potential costs in perspective, the entire California state budget for 2018-2019 is $201.4 billion. SB 562 does not provide details about how funds would be raised to pay for single-payer.

Furthermore, SB 562 has no mention of cost control measures, while explicitly saying there will be no co-pays, deductibles, or premiums. It plans to cover all medically necessary care, including medical, vision, dental, hearing, and reproductive services. Other services like chiropractic care and acupuncture would also be fully covered under the new program.

Many other countries have universal health care coverage and better health outcomes than the United States, an argument frequently used in favor of single-payer. However, many of these countries utilize free-market mechanisms that promote cost-conscious decision-making. These include price transparency, fewer regulations, consumer choice, and cost-sharing to prevent overuse of services.

Aside from the fundamental problems aforementioned, there are considerable political and legal roadblocks associated with implementing a single-payer system in California. Assuming that tax increases would be a necessity for funding purposes, a key obstacle would be gaining the two-thirds vote requirement for passing any such increases in the state legislature. Other obstacles include Proposition 4 of 1979, referred to as the Gann Limit, which limits state and local appropriations. Implementation of a taxpayer-funded single-payer system would necessitate repealing the Gann Limit or exempting the new taxes from the limit. Proposition 98, passed in 1988, requires that a certain amount of state tax revenues be diverted toward education funding and taxes for a single-payer system would fall into this category. So, once again, voters would have to approve exempting these new taxes from Prop. 98.

Proponents of the single-payer system believe that the new taxes needed to fund it could be addressed in legislation without requiring voter approval. The California Budget & Policy Center sees this as “very unlikely,” since it would require amending the state Constitution. When it comes to Proposition 98, the likelihood of exempting new taxes is less clear, since it depends on differences between the General Fund and Special Fund, potentially opening the door to a lawsuit.

Much uncertainty exists about the possibility of rolling federal funding into the California Health Fund (a new fund from which the state government would pay all medical expenses). The federal government funds Medicare and most of Medi-Cal, setting or at least influencing eligibility rules. This creates a hurdle to covering undocumented immigrants; federal funds are currently not allowed to finance any of the social services provided to this population.

The combination of the political and legal complications, SB 562’s enormous price tag, and the lack of cost-control measures and long-term funding uncertainties need to be carefully considered by Californians. Vermont tried to implement a single-payer health care system in 2014 but ultimately abandoned it following a myriad of challenges. Vermont had a population of 625,000 residents at the time. California’s is home to nearly 40 million people. Increasing access to health care is a laudable goal, but changes to the system should focus on improving health care outcomes for patients and  improving the quality and affordability of care. Increasing the state government’s role in health care is unlikely to deliver those results.

This article was originally published by Reason.com

Trump Blasts Newsom’s Universal Healthcare Plan for Illegal Immigrants

trump-debatePresident Donald Trump on Friday blasted California Lieutenant Governor and gubernatorial candidate Gavin Newsom for supporting universal health care for illegal immigrants, asking, “What happens if the whole world decides to go to California?”

Speaking at a North Carolina event, Trump said Newsom wants “health care for everyone. He wants everything for everyone. He wants to open up the borders. He wants to take care of everyone.”

“And I was just saying, what happens if the whole world decides to go to California?” Trump continued.

Trump said Newsom’s plan means “they’re going to take care of the whole world.”

“Where do you stop?” Trump asked. “You’re going to take care of a lot of people, but they’re not going to be able to do it for very long because it’s not going to work.”

Earlier this week, Newsom said he would like to extend San Francisco’s universal healthcare plan for illegal immigrants that he ushered in when he was mayor to the rest of the state.

“I did universal health care when I was mayor. Fully implemented, regardless of pre-existing conditions, ability to pay, and regardless of your immigration status,” Newsom said. “San Francisco is the only universal health care plan for all undocumented residents in America. Very proud of that. We proved it could be done without bankrupting the city. I’d like to see that extended to the rest of the state.”

Newsom also claimed on Twitter that offering universal health care to illegal immigrants is “the economically smart thing to do.”

“If we don’t offer coverage to everyone – regardless of income or immigration status – we will still carry the expense,” Newson said. “Universal access isn’t just the right thing to do – it’s the economically smart thing to do.”

This article was originally published by Breitbart.com/California