Research & Commentary: California’s Single-Payer Posturing

Published March 5, 2010

When the governor of your state compares it to “an accident victim bleeding to death on the side of the road” and has to go to Washington seeking $6.9 billion just to keep the lights on, it takes a certain kind of political hubris to propose a vast new state health care program expected to cost in excess of $200 billion in just its first year. But that’s just what California state Sen. Mark Leno (D-San Francisco) has done.

California is facing one of the worst financial crises in the country, with 12.4 percent unemployment, a small business bankruptcy rate double the rest of the nation, and a gargantuan $20 billion deficit that has raised questions about the primary drag on the budget: an enormous network of state-run social programs.

Leno’s legislation, which would dramatically expand that network through a single-payer health care program for the state, passed the California Senate by a 22-14 vote. While Canada and other countries are moving away from the single-payer model after experiencing its deficiencies, Leno wants a single-payer system funded with federal and state money, a payroll tax, and the supposed “increased efficiency” of government.

But Leno’s legislation is not a feasible policy plan and is largely a reaction to the stagnation of government-run health care at the national level. State Sen. Christine Kehoe (D-San Diego) told reporters recently: “If it’s not to be done at the national level, let us take the lead.” But Democrat Jerry Brown has declined to support the measure, and Gov. Schwarzenegger vetoed similar plans in 2006 and 2008. After looking at the truth about single-payer, it’s easy to see why this plan ought to receive the same treatment.

The following articles show the high costs and loss of choice involved in single-payer systems.


Lives at Risk: Single Payer National Health Insurance Around the World
This study provides comprehensive information about single payer programs around the world: “Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income–with rich and well-connected citizens jumping the queue for treatment. … In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments. And patients in countries with national health insurance usually have less access to critical medical procedures, modern medical technology, and lifesaving drugs than patients in the United States.”

Single-Payer: Neither Simple nor Smart
In a column for Health Care News, Dr. Michael Glueck and Dr. Robert Cihak point out single-payer politicizes health care decisions and reduces consumer choice: “Putting health care decisions into the political arena will subject them to partisan wrangling, and it’s a virtual certainty that, in the end, the politicians will decide they don’t want to spend as much money as patients require or hospitals and physicians need to do their jobs.”

California Single-Payer: Downfall of a System
Michael D. Tanner of the Cato Institute outlines the obvious deficiencies of a proposed single-payer plan in California that was rejected by Gov. Schwarzenegger in 2006: “Private health insurance would be abolished. The state would become the sole payer for all health care services. The bill does not specifically prohibit paying for a procedure out of pocket. … [It] does, however, require that doctors take all patients and in the order that they apply for service. Thus, you couldn’t jump the queue by paying cash. Nor could a doctor set up a cash-only practice.”

Schwarzenegger Rejects Single Payer Program
This article from Health Care News details the rationale for Gov. Schwarzenegger’s rejection of a single-payer plan in 2006, quoting the governor as declaring: “This bill would require an extraordinary redirection of public and private funding by creating a vast new bureaucracy to take over health insurance and medical care for Californians–a serious and expensive mistake.”

Single-Payer Empowers the Government, Not the People
Writing at the KQED blog, John R. Graham of the Pacific Research Institute notes the historical failures of social insurance: “the alternative, which Professor Chaufan calls ‘single payer’ but is more accurately named ‘government monopoly’ is even less palatable.”

Sebelius Insists: No Single Payer at National Level
U.S. Health and Human Services Secretary Kathleen Sebelius has consistently maintained that the single-payer model will not be introduced at a national level: “This is not a trick. This is not single-payer. That’s not what anyone is talking about–mostly because the president feels strongly, as I do, that dismantling private health coverage for the 180 million Americans that have it, discouraging more employers from coming into the marketplace, is really the bad, you know, is a bad direction to go.”


For further information on the subject, visit the Health Care News Web site at; The Heartland Institute’s Web site at; or PolicyBot, The Heartland Institute’s free online research database, at

Nothing in this message is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. If you have any questions about this issue or the Heartland Web sites, contact Managing Editor Ben Domenech at 312/377-4000 or [email protected].