About half that sum could come from existing Medicare and Medicaid dollars, according to the analysis. What employees and employers currently spend would cover another $100 billion to $150 billion. But the remaining $50 billion to $100 billion would require new taxes — such as a 15 percent payroll tax on earned income. A separate analysis put the bill’s cost at $331 billion, accounting for savings achieved through efficiencies and preventive care, among other things. Whatever the figure, even supporters concede that it would require a higher sales tax and increased taxes on large businesses. Ardent proponents, like the California Nurses Association, are undeterred. “It really is about the political will,” said Catherine Kennedy, a longtime nurse who lives in Carmichael, outside of Sacramento. “We can find the money.” Democrats overwhelmingly favor single-payer plans in polls, but the phrase means different things to different people. To some, “single-payer” is just a way of saying coverage for everyone. To others, it means eliminating the profit motive from health care. Or it represents simplicity — an end to paperwork, deductibles, co-payments and preapprovals. “I do support a single-payer system,” said Steven Cohen, a retired engineer, who lives with his wife, Terri, a retired schoolteacher, in Valencia. Even though he is on Medicare, Mr. Cohen, 71, said a recent switch in his medication for rheumatoid arthritis caused his out-of-pocket drug costs to rise sharply. The insurance and pharmaceutical industries now have too much clout, he said. When asked if he would still support single-payer if it meant higher taxes, however, Mr. Cohen said no: “Raising taxes to offset the cost of health insurance is not the best approach.” And he is unwilling to trade his Medicare coverage for a state-based version, “unless it changes for the better.” A nationwide Kaiser Family Foundation survey last September found similar sentiments. A majority favored the idea of a single-payer national health plan. But when those surveyed were told that the role of employers in health care would be ended, that governmental control would grow, or that people would have to trade in their existing coverage, support fell below 40 percent.
Single-payer health care is proving to be the litmus test for progressive Californians in the California ’s governor’s race. All the main Democratic contenders in the years primary have vowed to support a state-run single-payer system. Medicare , ex-mayor of San Francisco and frontrunner in the race, has even put it at the heart of campaign. Indeed, many Democrats from across the US are taking a lead from Bernie Sanders’ years presidential campaign, which pledged “ Medicare for All ,” in an attempt to energize supporters. But Kelly Hall , an independent health consultant, warned that while voters are thinking about the “fundamental values” of a single-payer system, hardly any have considered the policy implications. Even a wealthy state such as California could find itself hamstrung by money, legal and regulatory red tape and a highly-motivated opposition. Indeed, Newsom himself has warned that creating such a system could take years . Setting up an independent, state-run health care system requires not just visionary thinking but also the authority, financing and political backing to do so. Federal rules would prevent California from simply diverting health care funds spent in the state to an single-payer insurance system. Medi-Cal covers about a third of the population while almost everyone else is covered through an employer, Medicare or an individual marketplace, where the state has less authority. The state would need a federal waiver to divert Medicare funds, something unlikely to be granted. Medicare is also popular and if the state became the single payer, the current program would no longer be an option. Employer plans, which cover 43 percent of Californians , also pose a significant hurdle as federal law, in effect, prevents states dictating how private businesses should structure their plans. Even if such practical and regulatory hurdles were overcome, the rest of the funding to cover the uninsured would need to come from somewhere. The state could look to cut costs to expand coverage, which could prevent more serious illnesses and higher costs further down the line. But when people have more coverage, they tend to use it. A legislative analysis of a recent state bill offering free medical care for all residents predicted that the final cost would be $50-100 billion per annum – over double California ’s budget. Half of that would come from current Medicare and Medicaid funding, while what employers and employees spend would account for another $50-100 billion . But the remainder would need to come from new taxes, such as a 15 percent payroll tax on earned income, and many supporters of a single-payer system are less keen on paying higher levies to offset costs. A Kaiser Family Foundation survey in 2017 found that a majority favored single-payer health care, but when told that governmental control would increase, or that they would have to swap their existing cover, support dropped below 40 percent .