Should California health care be single payer or private? | Sacramento Bee

California Influencers this week answered these questions:

Is Gavin Newsom right to call for a single-payer health care system for California as a way of making health care more affordable? Is John Cox right to call for private sector-based health care in order to create competition and make health care more affordable? How confident are you that either would be able to achieve their goals as governor?

Laboni Hoq – Litigation Director, Asian Americans Advancing Justice

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“It is simply inhumane to deny health care to those who cannot afford to access it through the private market. The only way to address this problem is through some form of a single payer system, which serves as a backstop to ensure access to health care for all. This should happen at the federal level, but if it cannot, our state must fill the gap. We have both a moral imperative to do so, as well as a practical one – our robust economy will not sustain if we do not have a healthy workforce. Other states have successfully adopted a single-payer system — which has been endorsed by Republican governors — and we can and should too regardless of who becomes our next governor.”

Pete Wilson – California Governor (1991-1999)

“Gavin Newsom is dead wrong in his socialized medicine, single-payer campaign proposals. He told the Bee in April that the state is ‘on a path to insolvency’ with our current health care system. If his proposals become law, however, he will put us on a high-speed rail trip to financial ruin. The California Department of Finance estimates that a single-player plan would produce budget shortfalls of more than 40 billion dollars on an annual basis. Another estimate produced by the California Legislative Analyst estimates a single-payer plan in California would cost anywhere from $330 to $400 billion dollars annually—an amount larger than California’s entire state budget. For reference, total state spending amounted to $183 billion in FY 2017-2018.

“Newsom’s proposals would require massive tax increases that would cripple our competitiveness and establish a health care system requiring a risky and unprecedented redirection of private and public expenditures. It would also create a vast new government bureaucracy and add more than 6 million individuals who are not legally in the country to the healthcare rolls – not counting medical tourists or those from other states who would move to California to take advantage of our free healthcare.

“Besides, rarely do we see instances in which the government takes over something and runs it more efficiently. Instead, we have the recent scandals at the DMV, the overruns in FI$Cal, the continuously escalating costs of the California High Speed Rail and the Delta Pipeline project, and the outrageous cost in construction errors stemming from the more than two decades it took to rebuild the Bay Bridge. The only time government makes something ‘more affordable’ is when it cuts the services the project or system provides to the public. Medi-Cal is “affordable” because it offers to pay less than the cost of the service. Medicare is affordable because it gets to set the rate it will pay, and healthcare providers are forced to make up the difference with charges to other patients.

“Single-payer is ‘affordable’ in Canada and the UK, because they restrict the range of care provided to patients, and often those patients wait in line for months for care. This is what an ‘affordable’ single-payer health system would produce if it were to replace the existing system, with which most individuals indicate they are satisfied even with its flaws.

It’s bad policy, bad economics and, a bad prescription for California.”

Jim Wunderman – President and CEO, Bay Area Council

“Californians want and deserve a healthcare system that provides universal coverage and access to affordable, high quality care. Against that broad canvas, it’s important to understand that healthcare—and community health generally—is an extraordinarily complex area that eschews simple ideological solutions. While a single-payer system may have some advantages, the costs could reach into the hundreds of billions of dollars and would require a massive tax increase on Californians. And to achieve the level of health spending required, it could mean dramatically cutting the pay of nurses, doctors and other healthcare professionals.

“Putting all of our eggs in a purely market-based system, however, is also fraught with problems. Market-based competition can have a powerful influence on controlling prices, instilling accountability and spurring innovation, but it also may not serve the needs of all consumers. Hopefully the next governor will chart a more pragmatic middle path. This can be done by building on our current system and leveraging California market-based innovations including integrated health systems and precision medicine approaches. Both Gavin Newsom and John Cox would be wise to recognize that any solution for meeting Californians’ healthcare expectations will require a mix of approaches.”

Janet Napolitano – President, University of California

“Gavin Newsom’s call for a single-payer health care system is a noble goal with significant challenges. First, there is the cost that will strain an already-strained state budget. Second, the state must obtain a waiver from the federal government, which will be extraordinarily difficult during the Trump administration. Third, the state must have the demonstrated administrative capacity to design and carry out an implementation plan. Perhaps an intermediate step would be for Governor Newsom to focus on providing coverage for California’s remaining uninsured population. Closing the insurance gap would assist thousands of Californians while not presupposing a significant effort to achieve single-payer.”

Bonnie Castillo – Executive Director, California Nurses Association

“As Gavin Newsom has rightly noted, our present healthcare system is unsustainable. The rampant inequalities of a system based on profiteering, discrimination and ability to pay erode our standard of living and exacerbate income and wealth inequality.

“The market-based approaches favored by John Cox are exactly what created this crisis, and mirror the disastrous moves pushed by the White House and Congress.

“The U.S. spends far more than any other country on healthcare, but ranks just 31st in life expectancy, and on critical barometers as infant and maternal mortality falls behind other countries that have single payer type systems.

“Today some 15 million Californians continue to have no health insurance or pay premiums they increasingly can’t use due to escalating out of pocket costs. That must end. Only a comprehensive, publicly financed system, such as a state-based Medicare for all, will protect Californians, and can be achieved at savings for virtually all California families and businesses.

“Over the past year, thousands of Californians have worked to press Sacramento to enact guaranteed healthcare for all. By continuing to monitor progress toward this goal, and holding our elected leaders accountable, nurses are confident we can provide the healthcare security we need. “

Harmeet Dhillon—Republican National Committeemember and Partner, Dhillon Law Group

“Single-payer healthcare is contrary to our American principles of competition, choice, and excellence. The government does a poor job at running monopolies, and in other countries where single payer healthcare is in place, such as Canada and Great Britain, there are long lines for basic procedures, and older people are denied life-saving care for serious diseases due to rationing. As it is in California, we have a shortage of physicians who provide general and family medical services. Imagine how much worse choice and availability will be when the government adds low compensation, more bureaucracy, and less job satisfaction to the mix. Gavin Newsom’s plan is a disaster, a pie-in-the-sky concept long on rhetoric but devoid of practical considerations. It’s typical of a millionaire politician to propose ‘solutions’ that ignore the reality for the common man and woman. John Cox has the right, market-based solutions for Calfornia’s health care challenges, and can achieve his goals because his proposal is what Californians want and need—choice, quality, affordability.”

David Townsend – Founder, TCT Public Affairs

“This is the fundamental problem when you have a conservative on the ballot against a progressive. They play to their base to get elected and the base isn’t sophisticated enough to know they are being played. California cannot afford single payer health. The cost is $400 billion. And Cox plan is a ‘Faux Health Plan’ that doesn’t provide any meaningful coverage. And since Cox will not be Governor, what he says is irrelevant. Single Payer and Medicare for all are very different programs with significantly different impacts and costs. To reform and/or expand requires the federal government to agree. With are current president that seems highly unlikely. The discussion after the election will hopefully move away from pie in the sky slogans and move to strengthening and expanding Covered California.”

Daniel Zingale – Senior Vice President, California Endowment

“Health care consumers in the U.S.—including California—pay more for less. Meanwhile people in other countries spend less on health care than we do but enjoy better health outcomes. Why is that? For one thing, they’re not burdened by the cost inefficiency of our health coverage haves vs. have-nots. The next governor can fix that by finishing the job of Obamacare and making universal coverage a California reality. To do that means not letting the longer term goal of a single payer system distract from immediate steps to cover more uninsured people. At the same time, covering more people now should accelerate—not delay—the greater goal of a prevention-oriented system guaranteeing affordable access to all. Making the system affordable is the hard part. Try to imagine a new governor reviving the failed recent attempt by Washington, D.C., to dismantle and defund Obamacare and Medi-Cal in the name of private competition. People across the country rose up to reject handing their health over to competition in the hands of big companies that sell insurance, treatment, equipment and drugs. Californians are even less likely to buy into that. In fact, to reduce costs those making the most money off of health care will have to profit less. And some of those profits will have to go toward the prevention and community wellness strategies those other countries are using to get better health at lower costs. To do that here, California’s next governor will have to be willing to stand up to some powerful interests.”

Rosalind Hudnell – Former VP of Human Resources, Intel Corp and Former Chair/President of Intel Foundation

“Calling for a single-payer health care system in many ways makes sense given its fundamental description and philosophical intent. The challenge is and will always be trying to implement it. The devil is always in the details. We as a society accepted long ago the need to fund public education with taxes. Citizens who either never had children or those who no longer have children in the K12 system accept paying taxes to still fund it. That’s why it’s amazing we didn’t figure out long ago the need to fund basic healthcare similarly. The challenge now is the near impossible task of changing an out of control system that is capitalistic. Healthcare is a for profit industry. Creating a system that funds that with income taxes is, well, problematic. We need to decide what we stand for. Is it okay that a for profit company can raise the cost of something like EpiPens or Insulin to outrageous levels? In our current system apparently yes given it keeps happening and people are making money off of the increase. Using taxes to finance basic healthcare seems reasonable but we will argue over what is basic. Creating one set of rules of services offered, drug prices and minimum standards makes sense. But politics will dictate is something like abortion a basic service? It’s time for us to determine what we stand for then we can finally put the right plan in place.”

Kim Belshé – Executive Director, First 5 LA

“The debate on our state’s health care cost, quality and access challenges should not focus on ‘either-or’ answers, but ‘yes, and’ solutions. There is a role for public and private health plans, a role for government and a role for the marketplace. Our state’s approach to implementing the Affordable Care Act is built on bipartisan ideas, setting rules for the health coverage marketplace to protect all consumers while expanding public subsidies to ensure all families can access coverage and care. As a result of our collective efforts, 97 percent of California’s children now have health insurance.

“While the ACA and our implementation are imperfect – for example, we must increase the number of children receiving timely and appropriate early intervention and prevention services – California is demonstrating an approach that can work. Millions of residents have gained coverage through Covered CA and Medi-Cal. Those in the private market are no longer subject to pre-existing conditions exclusions and have greater premium stability via a more dynamic, competitive marketplace. Rather than presenting a false choice, we should be challenging our gubernatorial candidates to lay out a plan for tackling escalating health care costs and making the system work better for all, especially California’s children.”

Jon Fleischman – Publisher of FlashReport

“Government healthcare (which is what we are talking about here) is a bad idea in general. In America (and California is, I think, still part of the U.S.A.) we pride ourselves on the values of individual liberty and individual responsibility. The epic expansion in the size and scope of state government, with massive tax and spending increase (even by California standards) will have us more resembling countries in Europe, who embrace collectivism and socialism. We need reforms in healthcare to encourage competition to bring down prices, but a government monopoly will make things worse than they are today.”

Barbara Boxer, United States Senator (1993-2017)

“The issue of health care cuts to the heart of the quality of life of Californians and I believe Gavin Newsom understands this.

With the Republicans in Washington playing games with and hurting the Affordable Care Act, (aka Obamacare), we see prices rising on the health exchanges.

“My belief is that our next governor should do everything in his power to alleviate the stress on those Californians who are hurting from high premiums and junk policies. At the same time, he should not interfere with programs like Medicare, Medicaid, strong employer plans, veterans health and retirement programs that are fulfilling their promise.

“I do believe it would be very interesting to pursue a state public option plan that California could offer to those who are dissatisfied with their current healthcare. That plan could be basic and affordable and would act to keep the private insurance market competitive. I also support this public option idea at the national level but until there is a political sea change, all eyes will be on the states, giving our next governor a wonderful opportunity for leadership in this area.”

Tom Campbell – Professor of Law and Professor of Economics, Chapman University

“Single-payer eliminates the private sector for health insurance. This is likely to produce the same quality result as other government monopolies or near-monopolies. America does not do ‘socialism’ well. We do free-market competition well. People should be free to purchase the health insurance coverage they want. If we have single-payer, the government will decide what must be included in health insurance coverage. Some people may want catastrophic coverage only; childless couples don’t need family policies with pediatric care. Those choices are ignored when government decides one size for all.

There is, however, some role for government: for the poor, we should provide a voucher that will automatically cover a plain-vanilla health care policy, including emergency care. That policy should be available for purchase by anyone, but be free to the poor. For those with pre-existing conditions, we should fully fund the existing California program of a high-risk pool, with vouchers based on income. Those who could afford insurance but who show up at emergency rooms without any insurance should bear the cost of the service they get. Cox’s approach comes much closer to these principles; Newsom’s substitutes the government to impose choices on us.”

Antonia Hernandez – President and CEO, California Community Foundation

“Single-payer healthcare system is the ideal we are working for. The question is affordability. California should work to find a way to adopt single-payer within the next five years. Private sector-based health care has been in operation for decades and it has not worked. For those who cannot afford private sector health insurance it has been the government’s subsidies and not-for-profits that have provided some degree of coverage for those who could not afford access to health care.”

Ashley Swearengin – President and CEO of the Central Valley Community Foundation

“There are severe, unintended consequences to both candidates’ proposals. A state takeover of the health care industry in California through a single-payer system is heavy-handed. In theory, it controls costs, but it is financially unsustainable and does nothing to drive improvements in efficiencies or effectiveness in our health care system. Unfortunately, the hands-off approach that views the state as a passive player and looks to the private sector to simply ‘compete’ to make health care more affordable has already proven to be ineffective as health care costs continue to skyrocket.

“So, we know we need changes, but what’s the right path? Like most of our state’s complicated problems, the right approach is somewhere in the middle. The state should continue its focus on the Medi-Cal population but change its approach to cost reimbursements by giving providers a monthly “all in” fee to provide care for Medi-Cal patients with tight standards of care. Let private providers compete to provide the care at the required standards for the monthly fee.

“This approach incentivizes prevention, uses competition to drive efficiencies and effectiveness, and allows the state to do what it does best—control costs and regulate standards—while allowing the private sector to do what it does best: compete for the state’s business by improving efficiencies and effectiveness of care.”

Chet Hewitt – President and CEO, Sierra Health Foundation

“Gubernatorial candidate Newsom’s call for a single payer health care system demonstrates a willingness to advance toward the next logical stage of health care reform. The approach would allow the single payer to better control cost by reducing administrative complexity and leveraging its considerable purchasing power. But perhaps the most important consideration regarding candidate Newsom’s position at this point is not its potential for success; it’s the signaling of his intention to permanently establish access to health care as a right for every Californian as opposed to a product available to those that can afford it. That’s an outcome, regardless of the specific approach adopted, that I believe is achievable.

“The next best approach to single payer is the ACA, and any attempt to dismantle it in order to return to its predecessor is very concerning. If this is in fact what candidate Cox is suggesting, and I’m not certain it is, I’d argue that it amounts to an uninformed disregard for how and why the pre-ACA system failed us, and the particularly devastating financial and physical health related effects it had on poor individuals, families and communities. Given the signals coming out of Washington, D.C., we may see more erosion to the landmark ACA law but I don’t think back to the bad old days is where we’ll be heading in California.”

Kristin Olsen – Stanislaus County Supervisor, Former California Assembly Republican Leader

“California could lead the nation in healthcare policy if its leaders demonstrate the political will to say no to both business and labor. Neither a single-payer system nor a solely private sector solution will accomplish quality, affordable healthcare for all Californians. Government has a role in healthcare by ensuring access to care for all people, but it rarely operates as well as private healthcare companies when delivering service. We need a public-private solution that improves patient care and that holds both sectors accountable to positive health outcomes and affordable rates. We need leaders who acknowledge that access to medical care is often a greater barrier than whether one has health insurance.

“The next governor should rely on healthcare and business experts to develop a model that relies on the knowledge, efficiency, and medical training of the private sector while leveraging government funding to ensure sufficient providers in all regions of the state, effective reimbursement rates, adequate facilities, and a steady pipeline of future providers. It’s time to lead on healthcare in a fiscally responsible, patient-focused, and outcome-based way. Doing so will require tough political love and leadership—not promises by either candidate that can’t be kept.”

Aziza Hasan – Executive Director, New Ground Muslim-Jewish Partnership

“As someone who works to bring people together across differences, I realize that oftentimes, we dance around big concepts without truly addressing the issues. There is no substitute for direct conversations, and avoiding them will only allow problems to escalate. That being said, challenges in healthcare are larger than both proposed solutions. Addressing the reality of the challenges head-on in an effort to truly deal with affordability issues comes down to healthcare portability, industry transparency, and underlying costs of healthcare, like waste. The system already has a mix of private sector and government based support (i.e. Medicare), and current costs are continuing to increase. A real conversation around this issue would include detailing what health care portability would look like. For instance, electronic medical records with cross-talk communication transcending current proprietary systems or a state-wide repository for imaging like CT Scans would save time and reduce repetitive waste with costly tests when a patient sees a different physician. With people able to access life savings on their cellphones through online banking, it is also plausible that electronic records or a state-wide imaging repository could be made HlPPA-compliant and secure. Currently, neither candidate is addressing the roots of the affordability issue.”

Dorothy Rothrock – President, California Manufactuters and Technology Association

“Businesses in California are impacted by the burgeoning cost of healthcare because of their role in providing employee healthcare benefits. A government-run single-payer system won’t lower costs if it simply shifts costs to businesses and citizens in the form of higher taxes while taking away competitive market features that put downward pressure on costs. Whether the next Governor supports single-payer or reforms to create more competitive markets, it will be a tough political fight given the powerful stakeholders and importance of healthcare to every Californian.”

Mindy Romero – Founder and Director, USC California Civic Engagement Project

“California gubernatorial candidate Gavin Newsom has called for a single-payer health system for our state. But, for Newsom, this pledge is not simply driven by what is right or wrong. As with any political candidate’s policy choices, it is part of a complex political calculation that takes place in two parts. First, Newsom has to weigh how his position can benefit his campaign. Promising a single-payer plan won him the support of many progressive groups. Second, if elected this November — an outcome that is all but guaranteed, given the political dominance of Democratic voters in our state — Newsom will have to weigh the political, legal and financial challenges of implementing such a bold and expensive plan. Newsom’s aggressive agenda includes several other big-ticket items, such as universal preschool, eliminating homelessness and building millions of new housing units throughout the state. Each of these initiatives will come with a big political fight. Whether Newsom will actually pursue single-payer remains to be seen. Recently, Newsom signaled that he may be backing away from his primary campaign promise on a single-payer plan, resetting expectations for after he is elected by noting that it could take “years” to implement. In California’s political playbook, what’s ‘right’ is often only a small part of the political maneuvering involved in the policy decisions of our state’s leaders.”

Rob Stutzman – Founder and President, Stutzman Public Affairs

“No. Polls suggest 70 percent of California voters are content with the health care they have. There is no real single-payer plan that can legitimately promise Californians lower medical costs. And affordability alone is an inadequate way to evaluate health care proposals. Access and quality are huge issues with voters. Cox is well served to promote market based solutions that allow consumers to have choices and make providers compete. He also is well served to promote solutions that lower prices such as loosening scope of practice issues.”

Catherine Lew – Principal and Co-Founder, Lew Edwards Group

“Do I believe that competition between private sector interests will make health care more affordable? Hell, no! As long as for-profit insurance companies and Big Pharma are running the show, profit—not affordability for the most vulnerable patients who need it the most—will continue to be their bottom line. Making healthcare affordable and accessible to ALL Californians is long overdue and strongly championed by our physicians, nurses and teachers. Only Gavin Newsom has openly voiced his support for single-payer health care in the Governor’s race—and if he is elected Governor as we anticipate, it will be our collective responsibility to make sure he fulfills that commitment as promised. As for John Cox, he proposes no meaningful solutions other than the status quo, while the healthcare needs of thousands go unserved in the most successful economy in the world.”

Jon Coupal – President, Howard Jarvis Taxpayers Association

“Single-payer would be a disaster for California, both in terms of quality of care and costs. The LAO assessment of costs alone should take this issue off the table for the foreseeable future. (There’s the old saying that if you think health care is expensive now, wait until it’s free). Health care costs can be reduced by greater transparency, tort reform and allowing consumers to purchase health care plans from other states. One size fits all doesn’t work.”

Jim Boren – Executive Director, Fresno State’s Institute for Media and Public Trust

“The overall health care system has been whip-sawed around on the federal level as the Affordable Care Act was implemented and then partially dismantled by the Trump administration. The public is ‘dazed and confused’ over it all. With that as a backdrop, there’s little political chance of single-payer being implemented in California in the near future. Californians need to see how it would be paid for, and how it would be implemented to benefit their families. Pushing single-payer, without specific details, suggests you really don’t have a plan to make health care affordable and accessible to all. It takes hard work to build the political coalition across California to craft health care reforms that work for people living in such a diverse state. Let’s begin the work of reforming the current health system, and improving the health outcomes of Californians. If we really want to improve health in California, let’s clean up the toxic mess that too many of our citizens are exposed to daily. Let’s clean up our water and air, provide safe and affordable housing, build parks where we can exercise and relieve stress. Those factors are controllable if we really care about health outcomes.”

Madeleine Brand – Host, KCRW Radio Los Angeles

“The United States has the highest health care costs by far, and it’s a system based on private insurance. Therefore, if it’s simply a question of costs, a single-payer system would likely be more economical. Other countries with single-payer systems have lower costs. But quality is another consideration. Some experts say with single-payer there would be fewer incentives to provide cutting-edge treatments and there could be longer wait times for some procedures. Newsom has admitted it would be extremely difficult to get single payer passed soon. He says there would be lawsuits, ballot initiatives, not to mention the need for the federal government to approve the use of Medicare and Medicaid funds. Cox is in favor of the free market approach, which is pretty much what we have now. I’m not sure what exactly he wants to change or what his proposal is to lower costs. He’s talked about boosting the economy so that more people can afford health insurance.”

Roger Salazar – President, Alza Strategies

“Gavin Newsom is right in calling for continuing the conversation on how we get to a single-payer system. There isn’t a Democrat in California that opposes Health Care for All. The stumbling block is how to pay for it. John Cox would have you believe that the system that has led to skyrocketing costs and premiums; lack of coverage for most; excluding people with pre-existing conditions; etc., would cover us all if only we left it alone. He also believes that the legislature would be better if we had 12,000 more politicians. Ooookay.”

Cassandra Pye – President, California Women Lead and Founder and CEO, 3.14 Communications

“The answer isn’t nearly as simple as single payer versus private-sector based health care. Our modern health care system is full of complexities and layers and, as a provider friend of mine likes to say, so very many additional hands in the pot taking their share. Regulations require paid entities to manage costs – their fees tax the system. We’ve created an entire industry which tracks patient information – so now, in addition to creating another cost-layer in the system, the electronic health records (EHS) process is presently a source of massive frustration for physicians who say they spend more time on computers than they do with patients. Compliance officers, training for revisions around policies and procedures, boxes to check before certain medicines can be administered…all add to the burden and expense and have little to do with treating patients. Let’s not forget we’re also facing a physician shortage (in many cases, due to aforementioned frustrations). I would be more confident regarding solutions if the candidates (and the media covering them) would scale back on rhetoric and soundbites and peel away the many layers when addressing this issue before voters. Even then, the next Governor will have to contend with well-funded interests who won’t want to give away any of their portions of the health care pie.”

Angie Wei – Chief of Staff, California Labor Federation

“Health care is one of the most complicated policy areas at the state level. Everyone needs it, everyone cares about it. No one can afford it, and, if we stayed on the same path, costs will continue to rise. Why are wages stagnant? Partially because workers share of health care cost continues to rise. The system is unsustainable when private employers contribute vastly different amounts to cover their employee health insurance and 1/3rd of all Californians are covered under Medi-Cal. We need significant reform of our health care system. First step must be to control costs. We must bring down the cost of health care to get to universal coverage. All building on a system toward single payer health care. Is it achievable? It’s a long path but we have no other choice.”

Eloy Oakley – Chancellor, California Community Colleges

“Health care is one of the single greatest concerns on the minds of Californians - particularly young adults. Gavin Newsom is absolutely right in calling for a more comprehensive health care system for all Californians. John Cox is simply regurgitating the same tired conservative solution for health care. Having said all of that Mr. Newsom has yet to clearly articulate how California would pay for his plan. At this point I am not confident that a more comprehensive health care system could be done in the next few years but I am confident that it can be done by the end of the next governor’s term.”

Monica Lozano – President and CEO, California Futures Foundation

“Affordability continues to be a major concern for Californians seeking coverage and the next governor needs to balance access and cost. Private sector demand-based market solutions by themselves will not ensure low-income Californians have affordable coverage or that Medi-Cal enrollees get the care they need when they need it. The Affordable Care Act was a good step in the right direction, and any new program should attempt to provide equity in access to health services, quality that improves health outcomes and protection against financial risk. Finding a solution that works for all Californians must be a top priority.”

Bill Burton – Managing Director, SKD Knickerbocker Los Angeles

“Universal health care ought to be the goal of any candidate for office in California. But while we are a long ways off of finding the best path there for California, health care just would never be a real priority for Cox.”

Linda Ackerman – President, Marian Bergeson Excellence in Public Service Series

“Government-run universal healthcare is not successful. The results we see in existing systems are less access, long delays and need for care being based on arbitrary decisions made by non medical bureaucrats. Gavin Newsom’s plan for a single payer healthcare system would have to address the issue of poor health care at a higher cost. The price tag would be $400 billion and would require yet another tax increase for which Californians seem to have no appetite. History in the U.S. has shown that our private sector based healthcare systems (which are often accessed by citizens of countries with inferior single payer systems) are most effective and deliver quality care to all. John Cox’s plan would expand on our historical private healthcare and insurance systems to become more competitive without the need for more taxation.”

Timothy White – Chancellor, California State University

“Californians deserve healthcare that is accessible, high quality and affordable. Politics aside, any approach to affordable and accessible healthcare requires more highly trained healthcare professionals – preferably coming from the communities they will serve. The CSU is at the forefront of these efforts, conferring thousands of bachelor’s, master’s and doctorates of nursing on Californians each year. We are also leading research efforts into the fields of public health, social work, palliative care and more – understanding that a holistic and individualized approach to patient care is a key factor in reducing costs and improving outcomes.”

Mike Madrid – Principal, Grassroots Lab

“Selling single-payer to voters is irresponsible and impractical. Private sector based health care is insufficient. Both candidates lack the courage to fix the problem and it’s very unlikely either will accomplish their campaign promises on health care.”

Abby Porth – Executive Director, San Francisco Jewish Community Relations Council

“I recently, and for the fourth time, received a request to contribute to a Go Fund Me campaign for someone’s health care costs. It underscored the desperation so many Americans have in juggling financial obligations. It is in our nation’s self-interest to ensure that all of its citizens receive adequate medical care. Individuals’ economic stability contributes to the vitality of our society and economy. One way that California policy makers can preserve this State’s extraordinary global standing is by crafting health policies that will ameliorate Californians’ personal economic insecurity. Among the list of necessities is entitlement programs for the poor, elderly and disabled, the removal of unnecessary barriers to access insurance, affordable prescription drugs, simplifying and making possible universal enrollment, provision for all medical services necessary, and consumer protections, as well as creating cost efficiencies and reductions through the integration of medical, behavioral and long-term care services, the integration of Medicare and Medi-Cal for dual participants, and patient information sharing systems. A critical metric that voters and policy makers should employ to evaluate whether a proposed health care policy will be effective is to ask if this policy will—once and for all—remove health care costs from the list of leading causes of personal bankruptcy in America.”

Maria Mejia – Los Angeles Director, Gen Next

“California would be better served if our elected officials stopped managing for health outputs and focused on controlling for health outcomes. Yes, costs incurred by residents, governments, insurance companies and medical providers matter, and are a critical and essential component of the conversation. Yet, when we allow ‘costs’ to become the primary criteria for evaluation, we are less likely to achieve our larger objectives and more likely to propose solutions that despite merit get mired in political gridlock. We also handicap ourselves from thinking outside of the box and crafting ‘third way’ proposals that broaden and add much needed nuance to our understanding of what a modern day health care system can be to the people it serves. If Newsom, Cox and California voters can agree on the big picture, then let’s allow the conversation to start there, and push back on the national tendency to evaluate the strength of health care reform against the ‘big vs. small government’ framework that we allow to dominate all political dialogue in this country. After all, it is difficult, if not impossible, to place a value on human life.”

Kim Yamasaki – Executive Director, Center for Asians United for Self-Empowerment

“Healthcare accessibility is a fundamental human right. We need to work towards a single payer health care system in order to ensure quality standards of service and to regulate drug prices. Private sector based health care will put this at risk and jeopardizes the needs of our low income communities who often also rely on community clinics. We also need to accept that change doesn’t happen overnight. We need to have the policies ready to incrementally introduce single payer to our state as well as budget proposals to back any new health care program being proposed. The solution cannot just be to raise everyone’s taxes. Any new healthcare system roll-out needs to seriously consider implications for ensuring individuals have the information and resources readily available that they need to be in compliance.”

Edwin Chemerinsky — Dean and Professor of Law, University of California-Berkeley School of Law

“I think Newsom is right, that single payer is necessary. But no one seems to have figured out how to pay for it.”

Abby Porth – Executive Director, San Francisco Jewish Community Relations Council

“I recently, and for the fourth time, received a request to contribute to a GoFundMe campaign for someone’s health care costs. It underscored the desperation so many Americans have in juggling financial obligations. It is in our nation’s self-interest to ensure that all of its citizens receive adequate medical care. Individuals’ economic stability contributes to the vitality of our society and economy. One way that California policy makers can preserve this State’s extraordinary global standing is by crafting health policies that will ameliorate Californians’ personal economic insecurity.

“Among the list of necessities are entitlement programs for the poor, elderly and disabled, the removal of unnecessary barriers to access insurance, affordable prescription drugs, simplifying and making possible universal enrollment, provision for all medical services necessary, and consumer protections, as well as creating cost efficiencies and reductions through the integration of medical, behavioral and long-term care services, the integration of Medicare and Medi-Cal for dual participants, and patient information sharing systems. A critical metric that voters and policy makers should employ to evaluate whether a proposed health care policy will be effective is to ask if this policy will—once and for all—remove health care costs from the list of leading causes of personal bankruptcy in America.”

Carl Guardino – President and CEO, Silicon Valley Leadership Group

“Expansion of coverage to millions of Americans under the Affordable Care Act is a significant achievement, but we must still confront rising health care costs, poor health outcomes, inefficiencies, dissatisfaction, and quality and access issues. It is understandable that policymakers would seek new reforms to make healthcare more accessible and affordable, but overhauling a healthcare system is no simple task. Many may recall the long road for the Affordable Care Act that began in the summer of 2009 through the opening of the health insurance exchanges in the fall of 2013. Our own state’s health benefit exchange, Covered California, covers 1.4 million Californians. Rather than walk away from our current system, thoughtful and cost-effective solutions are needed to build upon the successes of the Affordable Care Act to truly make healthcare affordable and accessible for all.”

Eric Bauman — California Democratic Party Chairman

“Gavin Newsom is absolutely correct that single payer healthcare is the best way to make healthcare affordable AND universal. Californians overwhelmingly support the concept of single payer and they intuitively see healthcare as a right, not a commodity. Cox’s approach reflects the tired thinking of Heritage Foundation analysts, not the average person in California.”

This story was originally published August 27, 2018 12:01 AM.