Can single-payer health care become reality? The answer is a hard maybe.

There’s no politician – or patient or doctor for that matter – who likes the way we do things in our health care system today. The list of things to complain about is long: It’s too expensive; insurance companies are driven by profit motives that are at odds with good health outcomes; there are massive bureaucratic costs; public insurers like Medi-Cal are unable to compete with private insurance companies that reimburse doctors more per claim, leading many providers to accept only higher-paying private insurance, and in effect creating a tiered system.

Assemblymember Ash Kalra, D-San Jose, wants to blow all of that up and start over. His AB 1400, the California Guaranteed Health Care for All Act, would create a single-payer health care system in California known as CalCare. This bill has been a year in the making and faces strong political headwinds. At its first hearing on Jan. 11, in front of the Assembly Health Committee, AB 1400 received a reluctant 11-3 vote of approval, along party lines, but with a lot of skepticism from some of the Democrats voting yes.

A lot of their concerns had to do with cost – even though this massive shift will ultimately save billions of dollars. But the single payer would be the state government, and that’s not particularly popular. The way Kalra would pay for it is through a separate vehicle, requiring voters to approve new payroll and income taxes generating an estimated $163 billion per year.

“It’s not going to be free,” said Assemblymember Freddie Rodriguez, D-Pomona. “I’m still not there 100 percent.” Assemblymember Autumn Burke, D-Inglewood, was scalding in her remarks about cost, and the fact that voters will be asked to approve a tax hike to fund this system: “We are making even more of a mockery of this process.”

Member Cecilia Aguiar-Curry, D-Winters, was explicit in her intent to vote against AB 1400 if it makes it to the Assembly floor with a detached funding mechanism: “I will cast a reluctant aye vote today, but I will vote no for this on the floor,” she said. “I am not willing to cast my lot with platitudes.”

Here’s the thing about the cost of health care: It’s not platitudes, it’s real money. According to the Assembly Health Committee analysis, in 2018, California’s total health expenditures were an estimated $399.2 billion – that’s a whopping 13.2 percent of the state’s GDP. That breaks down to $10,086 in health care spending per person. Kalra estimates that from day one, his single-payer system would save $85 billion in administrative costs to hospitals and other providers connected to billing. (But resistance to change is evident everywhere. The committee raised the question of, what about the 160,000 people who work in insurance claims – shouldn’t we save their jobs to maintain a broken system?)

Speaking of platitudes, Gov. Gavin Newsom has plenty of those on the topic of health care. He campaigned on a promise of a single-payer system. And while he has yet to roll out such a system, he has taken steps to expand health coverage. “For me, single-payer is not a platitude,” he said at a Jan. 12 press conference. “When you’re governor, you have to be in the ‘how’ business.”

While AB 1400 represents one “how” – a full conversion to a single-payer plan – Newsom is operating incrementally. His Jan. 12 proposal would expand Medi-Cal to undocumented immigrants between ages 26-50, who are currently ineligble.

Newsom’s plan is a good one, but far from single-payer. In the latter, everyone, regardless of employment status, income, immigration status, etc. has the same insurance payer – the state of California – covering their claims, rather than a hodge-podge of private, subsidized and public plans.

“Politicians of all political stripes preach the principle. Elections come and go, politicians come and go,” Newsom said. “We finally are at a point where we are making those words real – we are implementing our ideals that so many of us have been preaching for years.”

And yet, Democrats appear be clinging to the private insurance industry, which in 2018 was the largest payer in California health care, at 32 percent. It’s a system no one likes.

It’s ridiculous that we’re still fighting this fight. An unwillingness to upend the status quo is all that stands in the way.

SARA RUBIN is the Weekly’s editor. Reach her at sara@mcweekly.com