Health

3 paths to universal health care in California

Backers of a single-payer system rally outside the South Gate office of Assembly Speaker Anthony Rendon in June 2017, after he shelved the single-payer bill, SB 562.
Backers of a single-payer system rally outside the South Gate office of Assembly Speaker Anthony Rendon in June 2017, after he shelved the single-payer bill, SB 562.
Robyn Beck/AFP/Getty Images

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The push to move California to a universal health care system enters a new phase this week, when a special committee will hear for the first time specific proposals on how the state might pursue a path to universal care.

The State Assembly's Select Committee on Health Care Delivery Systems and Universal Coverage has its two final scheduled hearings on Monday and Wednesday. On Monday, lawmakers will consider state and federal legal hurdles to universal coverage. The Wednesday hearing will be dedicated to hearing policy proposals, with testimony coming from Health Access California, Physicians Alliance and the California Nurses Association, among others.

Committee co-chair Assemblyman Jim Wood (D-Healdsburg) said the panel plans to produce a report with recommendations by the spring.

Assembly Speaker Anthony Rendon (D-Lakewood) shelved a single payer bill in June, arguing that it didn't lay out how to make such a radical transition or how to pay for it. Amid an angry backlash from progressive backers of universal care, Rendon announced the select committee set up to explore the issue.

There are a variety of possible paths California could take. But first, let’s define some terms.

"Universal health care" refers to everyone having access to quality health care without financial risk, according to the World Health Organization's definition. Despite improvements under Obamacare, nearly 3 million people in California still don’t have insurance. From the WHO's perspective, even if the state gets everyone insured, we won't have universal health care so long as there are people who can’t afford their out-of-pocket costs.

To get to universal care, activists have latched on to the concept of single-payer. That's when one entity - the state - foots the entire bill for everyone's medical treatment. It would cut out the private insurance industry, and would require a possibly significant increase in taxes. Proponents say that would be more than offset by the elimination of insurance premiums, deductibles, co-pays and other out-of-pocket costs. The bill Rendon shelved, SB 562, would have created a "Healthy California Fund" to be that single payer. 

Single-payer is one approach to universal health care, but not the only one. There are many different approaches to universal care around the world. If you want to become an expert on the health care systems of 19 industrial countries, The Commonwealth Fund has this deep dive.

Among the many systems in place, most are a variation on one of the three models below.

The Canadian Model

The United Kingdom Model

The German Model

This story was updated from its original version.