A very expensive free lunch: the estimated cost of California's proposed single-payer program would have been $400,000,000,000, while the state's total budget is $179,500,000,000.

• Author: Singleton, Marilyn M.
• Position: Medicine & Health

The California state senate's unipartisan passing of a sweeping single-payer health care bill, the Healthy California Act, has drawn attention to single payer as a solution to the decaying Patient Protection and Affordable Care Act. PPACA (ObamaCare) decreases competition and plan availability in health insurance and leaves patients holding the bag of unaffordable premiums, deductibles, and copays. It is no surprise that a majority of state residents polled were in favor of universal, government-run health care--as long as it did not raise taxes--but, as the fanfare died down, pragmatists in the state assembly put the bill on hold as "woefully incomplete."

This unrealistic legislation provides that every California resident--regardless of age, employment, or immigration status--would be eligible for coverage with no premiums, copayments, or deductibles. Additionally, patients could see any "willing" provider without a referral and receive any service deemed medically appropriate, including chiropractic, vision, dental, ancillary health, or social services, as well as National Institutes of Health-approved alternative therapies. Insurers would be permitted to offer coverage only for services that are not provided by the state.

"Providers" would be paid on a fee-for-service basis unless and until the Healthy California board establishes another payment methodology. The government thus has the unilateral ability to fix prices and payment methods--including state IOUs.

According to the California senate's own study, the estimated cost of the single-payer program is $400,000,000,000, while California's total budget for 2018 is a projected $179,500,000,000. The bill naively or slyly makes no mention of funding. The top contenders are (of course) a 15% employer tax, a 2.3% sales tax increase, a 2.3% gross receipts tax, and existing health care-directed Federal, state, and local funds.

California's default-funding method is fleecing the taxpayers and then redirecting targeted tax revenues. Recently, voters approved California's 2016 Health Care, Research, and Prevention Tobacco Tax Act, which added a two dollar per pack tax because the funds would go to physician training, disease prevention, medical research, Medi-Cal, and tobacco-use prevention and reduction. Gov. Jerry Brown now plans to shift some of the revenue to the general fund.

Then there is the lure of the Golden Bear. The Supreme Court ruled in Memorial Hospital v. Maricopa County...