#empocali1pay California and single-payer health insurance

While "states' rights" is sometimes perceived as a conservative thing, in reality it can be used by conservatives, liberals, or whoever. For example, the state of California maintains that the legalization of marijuana is a "states' rights" issue.

And sometimes the concept of states' rights transcends the political spectrum.

Take health insurance. In this country, there are two ways that health insurance can be offered - by having the federal government control everything about health insurance, or to have state governments exercise the control. Despite the fact that the Affordable Care Act and its possible Republican replacement were implemented at the federal level, they clearly fall on the "states' rights" side of things. For example, under the ACA, each state decided whether or not to set up its own state exchange. Under the newly-proposed bill, it appears that another task will be tossed onto the states:

President Trump and Republicans in Congress want to convert federal funding for Medicaid to block grants.

What does this mean?

While this probably would reduce funding for covering low-income people, it presents the unintended benefit of giving states more latitude in how the money is spent.

If Assemblyman Ricardo Lara has his way, California will exercise extreme latitude:

California State Sen. Ricardo Lara, D-Bell Gardens, introduced a bill Feb. 24 that would create a state-based, single-payer health care system. His plan envisions covering everyone in the state: Employees would no longer have employer-provided coverage, and those currently on Medicaid and Medicare would get their coverage from Sacramento.

Of course, single-payer proposals in the United States have been proposed before, and have died. Vermont's proposal faced a number of challenges, including this one:

The Shumlin administration, in its white-flag briefing last week, dropped a bombshell. In 2017, under pre-existing law, the state of Vermont expects to collect $1.7 billion in tax revenue. Green Mountain Care would have required an additional $2.6 billion in tax revenue: a 151 percent increase in state taxes. Fiscally, that’s a train wreck.

It's not necessarily a train wreck because single-payer would cost more than the current or pre-ACA system - I'm not sure if it would or not. The important thing is that it would cost something in TAXES. Employees and their employers could pay tons of money for private health insurance, but that is not PERCEIVED as a cost. An increase in taxes, though - even if it results in lower overall costs - is perceived as catastrophic. (Remember, that's how Bill Clinton became President, because of Bush 41's "read my lips" statement.)

In addition, as both the Los Angeles Times and KFI talk radio host Bill Handel have noted, there are different flavors of single-payer.

There are three basic approaches, as outlined by T.R. Reid in his excellent book “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.” Each has pluses and minuses:

Beveridge Model: Named for British social reformer William Beveridge, this is the system established in postwar England, Spain, New Zealand and most Scandinavian countries. Under this model, the government finances coverage through tax payments and also runs hospitals and clinics.

Pro: No doctor bills. You show up, get treated, leave. Con: Choices may be limited and certain costly treatments may be unavailable.

Bismarck model: Named for Prussian Chancellor Otto von Bismarck, who originated the idea in 1883, this approach relies on payroll deductions to fund nonprofit insurers and requires that they cover everyone. Coverage and medical pricing is strictly regulated by the state.

Aside from Germany, you’ll find variations of this system in France, the Netherlands, Switzerland and Japan.

Pro: Plenty of flexibility in choosing insurers and healthcare providers. Con: Doctors may seek higher fees through private clinics.

National Health Insurance model: Combining elements of both Beveridge and Bismarck, this is the system Canada started rolling out in 1947. All citizens pay into a government-run insurance program that deals directly with doctors and hospitals.

Pro: Costs are greatly reduced by administrative savings and efficiencies. Cons: Some treatments may be limited; long wait times for some patients.

So there's obviously some work to be done before Lara's bill can become law.

Most importantly, we have to see whether the federal government will actually provide that block grant that's being discussed.