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Lessons from the Demise of AB 1400

Summary: The recent non-vote defeat of California’s single payer bill, AB 1400, generated much scrutiny, soul-searching, and opining. We offer a survey. Prescriptions range widely: better explain single payer to political actors and business, accept a lesser version of “universal” care, throw in the towel on progressivism, double down on progressivism. Multi-pronged efforts seeking a true single payer solution seem inevitable and essential.

Single-payer health care is dead in California until these things change
San Francisco Chronicle
Feb 2, 2022
By Josie Lepe

Single-payer isn’t just dead for this year, it is dead for the foreseeable future unless its supporters can explain it better — starting with winning over people who, in theory, should be with them, like organized labor, Gov. Gavin Newsom and Kalra’s fellow Democrats. Supporters would have to elect at least 10 more progressive legislators this year to replace the current batch.

Polls have consistently shown that a majority of California voters support single-payer. But advocates still have trouble convincing people — from employers to state legislators — that while they will pay more in taxes under a single-payer system, they will ultimately save money.

“A single-payer plan is kind of nirvana for patients: Go to any doctor, any hospital, no premiums, no deductibles, no co-pays. That sounds like exactly the kind of system many patients would want,” Levitt told me. “The problem is that that system doesn’t exist now. So you’re asking people to take on faith.”

Employer-based health insurance was a failure during the pandemic. Here’s how single-payer healthcare could do better.
Business Insider
Feb 5, 2022
By Paul Constant

When ordinary Americans understand that a wealthy handful of people are making billions in profits off of their misery, the rules of the game tend to change very quickly. If we reach that tipping point, a plan like Kalra’s will be necessary to actually meet the healthcare needs of all Americans, not just fluff up the corporate balance sheets of a few big insurance companies.

Single-payer healthcare in California is out of reach. Universal healthcare is a better bet
Los Angeles Times
Feb 3, 2022
By George Skelton

It’s virtually impossible to pass legislation this revolutionary without hefty promotion and pushing from the governor. Newsom sat out this failed fight, although he ran for governor as a strong backer of single-payer. Since then, he has apparently been indoctrinated in political realism.

Gov. Newsom created a commission to develop a broad plan for universal healthcare. The panel hopes to report in April.

Single-payer seems out of reach. But universal coverage is close.

California liberals seethe after Democratic legislature kills single-payer
Politico
Feb 5, 2022
By Jeremy B. White and Victoria Colliver

The unceremonious collapse of California’s single-payer health care legislation — without so much as a vote — has the left desperate for answers.

The bill’s failure “illustrates what an uphill battle we have ahead of us,” said David Campos, a California Democratic Party official and single-payer advocate who is running for state Assembly. “I think we need to figure out where we go from here as a progressive movement,” he added.

Paul Song MD, President, PNHP California
Email, Feb 7, 2022

Of 80 Assembly members and 40 Senators in California, 56 and 31 are Democrats. Despite this overwhelming Democratic majority, there were only 20 co-authors on AB1400, some of whom may have signed on only to avoid a primary from the left in very progressive home districts.

The Governor, who ran as a candidate strongly supporting single payer, claimed he never read AB1400. And it was very clear that there was little to no true support among the legislature. On top of this, Blue Shield, the California Hospital Association, and CMA all donated significant money to the Governor for his recall fight and the CA Democratic Party has continuously received tremendous financial support from the same groups.

I was pleasantly surprised to see AB1400 get as far as it did, and believe this was largely due to the relentless grassroots and social media campaign waged by dedicated single payer activists who organized like never before. But, in the end, it was a bought and bossed Sacramento that continually caves to its corporate donors that failed us once again.

To my fellow activists, I urge you not to give up, but to remember the words of Dr. Martin Luther King, Jr. “Human progress is neither automatic nor inevitable. Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”

All options are on the table, including a “Dem Exit” strategy in which Democrats not beholden to corporate interests coalesce in a truly progressive third political party.

We must continue to educate and organize.

Comment by: Jim Kahn

What lessons should we take from the fizzling of AB 1400 in the California Assembly, with no vote?

To me, Assembly Member Kalra’s decision not to call a vote should be treated with deference. Clearly the vote numbers were lacking. The tactical decision to withdraw the bill, rather than force on-the-record votes, is beyond my expertise.

Why were the votes lacking? Corporate control of the Democratic party (along with the GOP of course). That is, a general bias toward business interests, profoundly exacerbated by generous political donations from the major beneficiaries of current health care financing. We see the same phenomenon in Washington, as in the piecemeal health provisions in Build Back Better and CMS support for Direct Contracting Entities, which privatize traditional Medicare.

How to respond? I’m not a political strategist, so I consulted the views of those who know more about the most viable paths to pursue single payer. As you see above, proposed solutions vary widely. I’m unwilling to accept a shabby alternative to single payer, e.g., a cobbled together “universal” strategy that leaves massive inefficiencies (including extracted profits) and huge coverage gaps that results in tens of thousands of excess deaths per year.

Which leaves two broad alternatives:

Continue efforts to convince the Democratic party to respect popular support for single payer. Elect more progressive Dems, and expand and empower public voice. Pursue initiatives in multiple settings. As Michael Lighty proposes in a January 27th op-ed, States Now Hold the Key to Making Medicare for All a Reality – “the terrain for winning universal, publicly-financed comprehensive healthcare looks increasingly favorable.” I hope he’s right, and that when a state does pass single payer, the federal government provides the needed cooperation.

More radically, contemplate a “Dem Exit” strategy, as Paul Song described to me. Build a truly effective non-corporate third party. The US has a history of party shifts; perhaps it’s time to revive that playbook.

Here in California, the next step is the Spring 2022 report of the Healthy California for All Commission, which may include a significant single payer voice.

Again, I’m not a strategist, and have no political crystal ball. So I endorse pursuing multiple potential paths to what is the clearly optimal solution – single payer.

My contribution? I’ll keep reading, analyzing, and writing … being, as always, a health policy analyst desperate to see health care justice achieved, and ready to support any promising political action toward that end.

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