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.

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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.


  1. They cannot even afford the retirement obligation they have to their employees let alone more Tax and Spend for Votes programs.

  2. If you want to see how a “California” version of “Universal Health Care Coverage” would actually work (even if we could afford to pay for it) take a long hard look at the Medi-Cal program. It is not pretty.

  3. It destroys individuals, families, cities, and can destroy a state.
    Debt is by far one of the enemies of a Free Nation.
    This crop of politicians elected by morons has no concept of what debt can do. My guess is that they have been living off the teat of government and they know nothing else.
    Debt and diversity will utterly destroy this state and this nation if we don’t get it under control.
    But if Democrat’s continue with their purchasing votes with tax revenues we can kiss this country goodbye.
    A Republic elects those who would steer the nation in the right directions despite what the majority might want, but not these imbeciles currently in office. Their goal is to steal money from the hardworking taxpayer and spend it on the lazy, incompetent, and illegal.
    God help us but this is an ignorant bunch in Sacramento and DC!

  4. We all know just how much the government thinks ” AFFORDABLE HEALTH CARE ” should cost . The the Proud to be an America Hater Kamala Harris , did somehow , through rigged voting , get into the White House , Medicare would cost 2500 bucks a month PLUS deductible and co payments .
    These America Hating Communists hiding behind being a Democrat stay in office it’s only a matter of time before there is war in the streets . Just like Brazil and Venezuela . A look at Venezuela is a glimpse of what these Traitors have planned for America.

  5. ” The Republican Party” is persona non grata in the State of California. The Clinton machine and the liberal left, starting in 1992, have captured the large coastal populations and the election of Obama created an
    unbeatable plurality within the State. Trump only garnered 31.62%. With
    the growing political strength of the minority “voters” California will
    probably revert back to the State Constitution of 1849 and, again, become a bilingual State.

  6. Gov Nuisance talking about a “a moral imperative” is an oxymoron with him banging his best friend’s wife while he had hottie wife Kimberly back at home.

  7. TheRandyGuy says

    Obama and the Dems knew that O-Care, once enacted, would never be repealed. It’s the same with Gov. Adulterer: He knows once this system is implemented in CA, it will never go away, regardless of the cost to those of us that pay taxes. One-party rule, CA. You keep doing this every chance you get.

  8. All comments are on point.
    However, if we were to entertain this fantasy, this would not even provide medical care! If the point is medical care for all, this would be the last way to provide it. Of course, they have other motives to wanting do to this, none of which entails medical care.

  9. The Dem’s have no real intention of state universal health care. It’s
    completely unaffordable and they know it. The high profile noise is only
    for vote support and fund raising.

  10. showandtell says

    The disastrous medical care that would result from such a plan —- even if it WERE affordable, which it isn’t —- is not even what one would wish for. I know in CA we are used to paying taxes to make things worse but this is ridiculous. The state would be wiped out financially so that it could provide barbarous medical care. Or no medical care.

    I’ve personally heard teacher acquaintances of mine express entitlement for free health care (and other things) in such a way that it gradually becomes clear they don’t think the money for it (and other things) comes from taxpayers. No, I guess it comes from Magic Daddy Government — it just appears!

    Wishful thinking sprinkled with fairy dust — what the heck do you do with that? Persuade such people with logic, facts, and numbers?

  11. Never forget the Oregon Medicaid study – the people on the Medicaid waiting list had better health outcomes than those were getting Medicaid care.

  12. Medicare for All patients will face a new task when they call their doctor: marche numero dos per espanol; push number three for Urdu.

  13. Define “health care” first before making any future moves. Define it without using the terms rationing, futility of treatment, death panels or EBM.

    What exactly are we buying – how much or how little of what/ We toss the term around as if it had specific meaning. It is like saying I would like to buy some jewelry and you pay for it.

  14. We want free housing – how much will that cost
    We want free health care – how much will that cost
    We want free college – how much will that cost
    We want free food – how much will that cost
    We want free income – how much will that cost

    What will it cost if we don’t hand out free housing, food, health care, and income?

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