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3 paths to universal health care in California




A healthcare reform activist wears a hat as she protests outside the office of US Speaker of the House Nancy Pelosi May 29, 2009 in San Francisco, California.
A healthcare reform activist wears a hat as she protests outside the office of US Speaker of the House Nancy Pelosi May 29, 2009 in San Francisco, California.
Justin Sullivan/Getty Images

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The Republican push to repeal the Affordable Care Act has had some unexpected consequences: Not only has it strengthened public support for the health law, but it has led to heightened interest in ending the U.S.' status as the only major industrialized nation in the world without a universal health care system.

That dynamic is playing out in California, where the state legislature this year considered a bill that would create a single-payer system. Assembly Speaker Anthony Rendon (D-Lakewood) shelved the measure 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 subsequently called on a select committee set up to explore the issue to hold hearings this fall on possible approaches.

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 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. Rendon said the select  committee will consider all of them in its hearings this fall. 

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