Public Option: the Single Payer Salve

Single payer proponents are still stung by the loss of their big issue to other big issues — or big players, if you will — but the prospect of a strong public option is the balm that may still salve that wound. This was one of the messages delivered by Giorgio Piccagli, President of the California Public Health Association, North and member of the Executive Board of the American Public Health Association at a panel discussion tonight sponsored jointly by OWL of San Francisco (The Voice of Midlife and Older Women) and the League of Women Voters of San Francisco. Audience members were urged to fight, among other things, for retention of the provision which would allow states to have single payer. (A California single payer bill passed the Senate Health Committee this spring and will be heard by the full Senate in 2010.)

Fellow panelist Debbie LeVeen echoed the call, saying a “robust public plan” must be national, to insure it’s large enough, must have authority to set prices and to bargain on drugs, and use the Medicare provider network.

Backing his call for reform with increasingly heard data such as sobering figures about uninsured Americans (45 million uninsured and another 50 million under-insured, for a total of about 1 in 3 of us) Piccagli said the lessons of the past 40 years include the fact that classical economics of supply and demand do not apply to health care: increasing the number of doctors, or competition among hospitals, only results in rising costs.

If the energies formerly tied to single payer can be channeled into a push for a public option some feel a viable reform bill will emerge. The San Francisco audience, many of whom were fervent proponents of single payer (which was endorsed by both OWL and the League of Women Voters) and most of whom are seasoned activists, left the room armed with cards to send appropriate legislators and plenty of ammunition to support their call now for a public option.

Said the third panelist, Co-Director of the Center for Policy Analysis Ellen Shaffer, about prospects for a robust public plan, “I think it’s up to us.”


  1. PS, Rick, I forget you’re a Californian yourself — we can get pretty provincial up here around the Bay — and you undoubtedly know all this. I’m still eager to see how Leno does. He is sharp and persuasive, and I sometimes argue that we’d be better off if all legislators had rabbinical training.

    1. Fran I didn’t realize you live in the Northern part of CA. I’m up there all the time (doing some advising to the Newsom team) plus family up there. I’ll have to buy you lunch one of these days!!

  2. You are assuming that the California legislators are capable of handling the costs to get a single payer off the ground…any movement in this direction will fill supermarket lots with hundreds clipboard activists.

    1. Actually, I don’t think that the CA legislator would go for a single-payer system. However, I think there is a good chance they would go for state based public insurance option that runs on its own profits and losses.

  3. Fran- you are on to something here that people need to start thinking about.
    I don’t agree with Debbie LaVeen who feels that a single-payer approach must be national to have sufficient bargaining power – particularly when we are talking about California. California is the 8th largest economy in the world. We can do this on our own. Indeed, Gavin Newsom has made a pretty good case in San Francisco that even a city of S.F.’s size can pretty much pull this off.
    There is, as always, a fly in the ointment. WHile the nation perceives California as an ultra-liberal state- it really is not. The balance between liberals and conservatives, even ultra-conservatives, is very tenuous in the state. Thus, I’m not so sure that such a bill could make it through. But it would be well worth fighting for.
    Given the strong likelihood that the creation of the health exchange will happen in the federal bill we end up with will be done on a state by state basis, this also presents California with the opportunity to create its own state option which can be included in our statewide health exchange. This might very well be “sellable” to Californians.

    1. LeVeen (and I might not have been clear enough on this) was not arguing for single payer to be national — I think that’s pretty much off the table — but for a “robust public option” to be national, and for the single payer choice left possible for any state. You’re right that California is a mixed political bag, including pockets of arch conservatism that would make Louisiana look mainstream. It’ll be interesting to see what happens if the state option comes to pass, though. A single payer bill introduced by Sheila Kuehl was passed by the CA Legislature twice (2006 and 2008) before she was termed out, both times vetoed by the Governor; now Sen. Mark Leno has taken up the torch, with a bill that passed out of committee last spring.

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