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Single-Payer Health Care System Proposed For California

A mother and daughter wait to meet with an enrollment counselor to sign up for health insurance at a Covered California event in Sacramento, Feb. 12, 2015.
Associated Press
A mother and daughter wait to meet with an enrollment counselor to sign up for health insurance at a Covered California event in Sacramento, Feb. 12, 2015.
Single-Payer Health Care System Proposed For California
Single-Payer Health Care System Proposed For California GUEST: Dr. Robert Hertzka, health care policy instructor, UC San Diego School of Medicine

It is Monday, February 20. The top story on the midday action, as legislators in Sacramento try to figure out how to preserve and cover California if they dismantle Obama care, state senators are proposing a bold alternative. Senator Laura and Toni Atkins has introduced a bill that will create a single payer healthcare system. It has no details right now but it is expected to be fleshed out in the next several months. The single payer or Medicare for all, it has a lot of supporters but it remains to be seen if a state has the resources to pull off. We have Dr. Hertzka who teaches at the use easy school of medicine. Welcome to the program. I am happy to be here. Remind us what a single-payer system would look like and how would it be different from what we have? The single-payer system involves a administration, it is discussed through a governmental entity. They wouldn't buy interest from Aetna, it would resemble a traditional Medicare. Even Medicare, seniors are doing is. There is a health plan. We would use online resources that a single entity would decide how much each would receive and how the services are compensated. It would be like Medicare in terms of negotiations. There is a fee schedule and a significant amount of taxes collected from people. It would not be insurance premiums, you cannot seize the dollars. You have to reconfigure things so you would do a tax rate in the past. They talked about a 12% across-the-board payroll tax on all income from janitors to the CEOs. They found that that would be $88 billion short and it created a lot of political consternation. We will go down that path. I think it is fine that people are interested in is. I am interested in see what the numbers would be. One of the challenges involved, it is the tax that is a big challenge. Are there challenges involved in seen -- looking at the healthcare providers leave this -- leave the state because they are afraid of not being compensated? What is the hurdles involved in putting something like this together? That is the position that is a concern. The Medi-Cal program, it is legendarily known across the nation for compensating physicians. The specter of a payment grade that is remotely near that level is desirable. It will be possible for a medical group to recruit the way we do now. That is one thing. The flipside is, everybody in Arizona and Nevada and Oregon, you can go in and have the system where they have to provide care. It is paid for. Essentially, the design is that the cost to the patient is usually essentially almost 0 versus now the co-pays and deductibles -- it is desirable from the patient point of view. There would be concerns about the influx of people on the one hand and deflects of positions on the other. Those are legitimate concerns that need to be addressed. When it comes to a single state putting this together, what happened and what lessons can we learn? I think that is worthy of looking at. If a bill like this passes and we start to analyze this, that is the first place people will. Vermont is an area where this is wildly popular. Think of 600,000 Bernie Sanders supporters in one state. That is Vermont. The people were in favor and legislature was overwhelming. The government said they would deliver. There was no political opposition. When I looked at it and they saw what it would cost to pay for this, they pay for modern healthcare and modern hospitals with cutting edge physicians, they said they would not be able to generate revenue. The governor's address to the state and said they would have to pull the plug on it. And California, we have a fairly successful health exchange. With that pave the way for a single-payer plan? There are so me things you have to go through. The fact that it would probably involve an online exchange which would be of fantasy in 2008. Sure. There are questions that could be answered on how you would administer this and you have problems on the website and the affordable care act started that but the big issue is the fiscal issue and connecting the dots and making it paid more. You know how to do with exchange, you spend a few million dollars less figuring out how to set up the exchange. In the context of $88 billion, that is modest. More people have health insurance that is an advantage if you were going to switch to a single-payer? You have 5 million people and the Medicaid program that I mentioned earlier, we have a lot of data on the utilization and the management of these people. All of that is fine. What drives that to, we did a lot with the affordable care act and we brought this together. I have to take issue with your initial comment that the people in DC dismantling. I spent a week there it while ago. Every relevant person that I spoke to is talking about fixing it. The plan is under consideration right now. It would ensure more people than are currently covered. That is what I was going to ask you. Even though you were saying you would like to look at a plan, you will see what it was like for California, do you think a lot of energy should be expended on this considering that restoring as much of the affordable care act or health insurance for as many people as possible is the goal and are maybe too many challenges? Speaking as a physician who is in an efficacy role, I would not object to a steady single-payer. I believe that I would not like to see the state energy put in that direction because I do not think it will be fruitful but from a political point, this is fine but we have been down this path. We know where it is going. I would rather make the adjustments to the affordable care act that make it -- and make it better. And I think that is where our energy should be directed. I am speaking with Dr. Hertzka . Thank you. Toni Atkins will join us to talk about the single payer legislation that she is proposing for California.

Democratic state lawmakers have introduced a bill to create a single-payer health care system for all Californians, including immigrants living in the state illegally.

State health insurers have long opposed such a government-run system, saying it could decrease access to quality care and lead to massive budget deficits.

One of the bill's authors, Senator Ricardo Lara (D-Bell Gardens) did not provide details on how the system would be funded. Lara said that he will examine the Legislature's past efforts which have never become law.


"We know Californians fully support health care and health for all," Lara said. "We're in the situation now [of] responding to the looming threat from the federal government to dismantle the Affordable Care Act and we need to be prepared."

The proposals, which call for a tax on employees and employers, come as Republicans in Washington, D.C. promise to repeal and replace the federal Affordable Health Care law.

The proposed single-payer system would be funded by the taxes levied on employers and employees combined with Medicare and Medicaid funds.