Let's start with a flashback. The year was 2015 and the deep blue state of Vermont was abuzz over the prospect of enacting a first-in-the-nation statewide guaranteed healthcare system. Single-payer, long a dream of progressives, was coming to the small, liberal, homogenous, healthy state. Then reality intervened. The hype and ideological excitement ran into the buzzsaw of costs, and the whole endeavor was derailed:
For decades, liberal activists yearned for a European-style, single-payer health system that they argued would lead to more affordable, efficient, and comprehensive medical coverage for all citizens. When Vermont four years ago enacted a landmark bill to establish the nation’s first single-payer health care system, they saw their long-sought dream about to be fulfilled. But reality hit last month. Governor Peter Shumlin released a financial report that showed the cost of the program would nearly double the size of the state’s budget in the first year alone and require large tax increases for residents and businesses. Shumlin, a Democrat and long-time single-payer advocate, said he would not seek funding for the law, effectively tabling the program called Green Mountain Care...The decision not only stunned and angered supporters in Vermont, but also signaled that the dream of universal, government-funded health care in the United States may be near its end...In short, if a liberal state electing a Socialist (US Senator Bernie Sanders) to Congress can’t or won’t put a single-payer system into place, then who will?
"Then who will?" We'll get to that in a moment. But first, a summary of the math that crushed leftists' single-payer dreams in Bernieland, per the Boston Globe:
The numbers were stunning. To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion. Shumlin’s office estimated the state would need to impose new personal income taxes of up to 9.5 percent, on top of current rates that range from 3.55 to 8.95 percent. Businesses would be hit with an 11.5 percent payroll tax, on top of 7.65 percent payroll taxes employer pay for Social Security and Medicare. And even those tax increases might not have been enough. The governor’s office estimated the Green Mountain Care program would run deficits of $82 million by 2020 and $146 million in 2021. Shumlin said he feared the tax increases would harm businesses and the economy.
Government healthcare in Vermont, which is about as favorable a legislative petri dish as can be imagined for this experiment, would have approximately doubled the state's entire budget -- requiring tax hikes so dramatic that even the liberal state's liberal governor couldn't bring himself to even try it. Back to the question above. "Then who will?" Enter California. The batty left-wing state out West, controlled entirely by Democrats, appeared poised to do what Vermont could not. The state's top leaders have endorsed single-payer healthcare (in fairness, Vermont went further than this, passing a framework, then retreating at the implementation stage) and California's activist class and powerful union usually run the show. A vote, we were told, was imminent. And how was the math, which torpedoed the Vermont adventure, looking in the Golden State? In a word, bleak:
A proposed constitutional amendment (ACA 11) in California would increase taxes by $12,250 per household, roughly doubling the state’s already high tax collections, to fund a first-in-the-nation single-payer health-care system. The top marginal rate on wage income would soar to 18.05 percent—nationally, the median top marginal rate is 5.3 percent—and the state would adopt a new 2.3 percent gross receipts tax (GRT), at a rate more than three times that of the country’s highest current pure GRT. All told, the new tax package is intended to raise an additional $163 billion per year, which is more than California raised in total tax revenue any year prior to the pandemic...This is not the first time California lawmakers have considered creating a single-payer health system, which previous estimates pegged as requiring $200 billion in additional state funding. This assumes, moreover, that California secures federal approval to redirect approximately $200 billion in federal funding toward a health-care match, since the full cost of the program is about $400 billion per year. Even with that match, the numbers only balance if a single-payer system generates significant cost savings, an assumption that is, at minimum, controversial.
They would double their taxes, and that would raise less than half of the total annual price tag of the program -- and tens of billions less than the state's expected tab, assuming (a major assumption) that the feds would provide the other half. In perpetuity. To make the arithmetic work, "cost savings" would have to materialize, which many experts say is a pipe dream. Reality (there's that pesky word again) usually cuts in the other direction, as Californians have leaned the hard way on their endless "high speed rail" journey. Over to you, New York Times: "When California voters approved a bond in 2008 for a high-speed rail system from Los Angeles to San Francisco, the project was supposed to cost $33 billion and be completed by 2020. The job is now projected to finish in 2033 for $100 billion." Despite previous failures and the daunting numbers, California is known for insane, destructive decisions under left-wing governance, so there was a reasonable chance that they would plow forward anyway. But the fantasy was evidently too much, even for left coast Democrats. Leadership realized they wouldn't have the votes, so they scuttled the vote altogether. For now, it's dead:
California Democrats on Monday failed to gather enough support to advance a government-funded universal health care system, succumbing to intense pressure from business groups and the insurance industry in an election year. The bill had to pass by midnight on Monday to have a chance at becoming law this year. But it never came up for a vote after its Democratic author, Assemblymember Ash Kalra, realized it would not pass. "It became clear that we did not have the votes necessary for passage, and I decided the best course of action is to not put AB 1400 for a vote today," Kalra said. While the measure would have created a universal health care system and set its rules, it did not say how much that system would cost or how the government would pay for it...debate about the bill had been dominated by costs. A study of a 2017 proposal in California estimated it would cost $331 billion, which is about $356 billion today when adjusted for inflation...California's total operating budget — which pays for public schools, courts, roads and bridges and other important services — is roughly $262 billion this year.
That's some special framing by NPR, leading with an assertion that the effort succumbed to lobbying from business groups. Actually, it succumbed to...reality. California had no way of coming close to paying for this unfathomably huge Goliath, which would much more than double the entire state budget. Progressives are fuming that no vote was called because they're demanding an on-the-record roll call to target Democratic lawmakers who weren't willing to let the state commit economic suicide. If legislative genius Chuck Schumer had been running the show, they'd probably have held the failed vote anyway, just to make a point, or something. Crucially, in case you'd forgotten, the price estimate for national single-payer healthcare is $32-38 trillion over ten years. That's more than Biden's failed, one-shot BBB legislation would cost...but every single year. And since we mentioned Schumer a moment ago, I'll leave you with this:
Diversity on the Supreme Court is such a hugely important issue to Chuck Schumer that he doesn’t even know about Thurgood Marshall https://t.co/KRJ6eIUbm6
— Eddie Zipperer (@EddieZipperer) February 3, 2022
Incredible that he can say this with a straight face after he and President Biden both led blockades against Miguel Estrada and Janice Rogers Brown so they would never serve on the Supreme Court. https://t.co/r9oExrv70F
— Matt Whitlock (@mattdizwhitlock) February 3, 2022
Schumer and his speechwriters evidently forgot about the first black justice, who was placed on the Court nearly a decade-and-a-half before 1981, during black history month -- while trying to make an identity politics point. They're also hoping the rest of us will forget about Janice Rogers Brown and Miguel Estrada. We won't.
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