California Gubernatorial Debate Left Big Stone Unturned

Earlier this week the San Francisco Chronicle hosted a debate among the four announced Democrats for governor. Based upon the paper’s post-debate editorial, they left a big stone unturned.

A health care provider (the California Nurses Association) has sponsored a bill (SB 562) in the California Legislature to establish what it refers to as a “single-payer” system. But as explained here, SB 562 has little in common with successful single-payer systems around the world. The bill is less about successful universal coverage than about profiteering without necessarily producing better health. It’s as if the sponsors appropriated the phrase “single-payer” to title an “enrich-me” bill.

But from the reporting it appears the moderator didn’t ask about any of that. Likewise, the moderator didn’t ask about other ways universal coverage is provided around the world, such as the successful multi-payer universal coverage systems of France and Germany. So far as I can tell, the moderator didn’t even ask if contestants knew the percentage of Californians already covered (90+ percent). But worst of all, the moderator didn’t ask contestants how they would fix California’s existing single-payer system.

One-third of Californians — 14 million people — are already covered by the state’s existing single-payer system, Medi-Cal. Despite a doubling of spending over the last seven years — spending growth that crowded out funding for UC, CSU, parks, courts and social services and consumed a large share of proceeds from a tax increase — and surging revenues for providers, Medi-Cal beneficiaries have difficulty getting appointments, emergency room visits are up, and there’s no evidence Californians are materially healthier. There are a number of steps California’s governor and legislature could take, such as as freeing up nurse practitioners, using fire departments as providers, focusing preventive attention on patients who command a disproportionate share of spending, boosting participation in pre-paid plans that reduce incentives for excess utilization, and more. But the moderator didn’t ask.

Discussing single-payer without addressing the state’s existing single-payer system is mind-boggling.

At a minimum the debate should’ve made clear that successful universal coverage systems impose strict cost and utilization controls, which are completely absent from the current single-payer bill. Without such controls, education and other programs get crowded out and taxes and profiteering rise without producing better health.

Debating single-payer without addressing the state’s existing single-payer system is akin to responding to a request by your mutual fund to manage more of your money without asking how well or poorly it’s managing the money you’ve already invested. We all owe our fellow citizens a duty to make informed decisions about politics. Debate moderators should help.

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