The state Senate’s vote to pass Ricardo Lara’s single-payer healthcare bill last week was a singular act of fiscal malpractice.
By failing to control costs and access to the program – and by leaving unanswered how or whether federal funds could be leveraged – Sen. Lara’s Healthy California Act amounts to a blank check for hospitals, doctors and pharmaceutical companies on the state Treasury, a blank check that could well bounce once it’s presented to Sacramento.
While there are many reasons to dislike the concept of single-payer health coverage generally, it can be made to work on some level.
The United Kingdom and Canadian provinces have implemented forms of single-payer coverage without causing a fiscal meltdown and while achieving acceptable life expectancies. However, both systems suffer from long waits for certain medical services.
But the UK and Canada accomplish this outcome through cost controls missing from Sen. Lara’s bill. For example, these systems do not normally provide free healthcare to undocumented residents. To qualify for Ontario’s Health Insurance Plan, one must not only live in Ontario but must also be a Canadian citizen or legal resident. The province recommends that visitors purchase private medical insurance. The UK National Health Service also has provisions to charge individuals who are not legal permanent residents.
By contrast, Sen. Lara’s bill provides free healthcare to any “individual whose primary place of abode is in the state, without regard to the individual’s immigration status.”
With healthcare costs now averaging about $10,000 per capita, the state’s free healthcare will create a strong incentive for people to come to California illegally or overstay their visas.
And this incentive is not limited to foreigners.
Individuals from other states diagnosed with expensive medical conditions could legally move to California, establish residency and start obtaining free medical care.
Although the bill does not define what would be required to establish residency, the published criteria for getting a California driver’s license – a potential model – are quite lenient.
If that is the standard, one would merely need to produce a lease and a voter registration postcard to qualify.
The UK and Canadian systems also limit the types of care eligible for coverage.
As I discussed in a March article for The Fiscal Times, the UK National Health Service generally does not provide mammograms for women under 50, does not offer routine colonoscopies and does not cover circumcisions for newborn boys. In Ontario, the government dropped coverage for eye exams, chiropractic treatments and physiotherapy in 2004.
By contrast, the Healthy California Act proposes to cover “all medical care determined to be medically appropriate by the member’s healthcare provider.” Further, plan members “shall not be required to pay any premium, copayment, coinsurance, deductible, and any other form of cost sharing for all covered benefits.”
Although the bill claims to create “a healthcare cost-control system,” it does not contain any specific cost control provisions.
Mr. Joffe may be contacted at www.californiapolicycenter.org