Single - payer health care is proving to be the litmus test for progressive Democrats in the California ’s governor ’s race . All the main Democratic contenders in the June 5 primary have vowed to support a state - run single - payer system . Lt Gov Gavin Newsom , 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 ’ 2016 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 enthusiastic about the “ fundamental values ” of a single - payer system , hardly any have considered the political implications . Even a wealthy state such as California could find itself hamstrung by political , 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 vision 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 about $ 400 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 . 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. 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 .
Single - payer health care is proving to be the litmus test for progressive Democrats in the California ’s governor ’s race . All the main Democratic contenders in the June 5 primary have vowed to support a state - run single - payer system . Lt Gov Gavin Newsom , 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 ’ 2016 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 enthusiastic about the “ fundamental values ” of a single - payer system , hardly any have considered the political implications . Even a wealthy state such as California could find itself hamstrung by political , 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 vision 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 about $ 400 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 .