Kutsin said the Affordable Care Act has advanced in the national conversation about whether healthcare should be a fundamental right – a belief that every major Democratic presidential candidate says they are for them, but healthcare is still is rooted in the United States as an earned employment-related benefit. And 14 Republican-controlled states have not yet expanded Medicaid to older children, while others are hindering the qualifications of poor people.
Like the faithful advocates of a single payer, Kutsin believes that a single financing system can achieve universal coverage and make it cheaper. But this ignores the political realities.
"I'm afraid that getting to a payer from where you are now creates a lot of resistance that risks losing the purpose of universal care," he said. "The reality is, and I think it's difficult, the system is so messed up at the moment that it is almost painful to reach these goals almost every time. But standing still is also really painful.
Tsung-May Cheng, a Princeton health policy researcher who studies single-payment systems worldwide, said that the policies Newsom has developed could ultimately lead to a single payer.
"Fix Obamacare ̵
She said the steps Newsom took were in line with the pragmatic measures that she and her late husband, economist at Princeton Uwe Reinhardt, believed that states could handle Obamacare. In his study of uncontrolled prices, Reinhardt helped create Taiwan's one-payment system and broadened America's understanding of why the United States spends more on health care than any other industrialized country, but still has poorer health outcomes.
Chen said that if California could ultimately achieve universal coverage and go through rigorous cost control mechanisms to reduce overall health care costs, it could serve as a model for other states and possibly provide a state and a national single-payer template.
"You're almost there," she said. "The only downside to California and Obamacare is that there really is no cost control mechanism and this is necessary. If you manage to get universal care and spending under control, then there you are. "
But, she said, the partial steps California is taking" can push morale for the entire country, "as Democrats and Republicans struggle over the right approach.
The state has already reduced its unsecured rate to about 7 percent, up 10 percentage points from the first days of Obamacare. The measures taken this year are expected to broaden reach and access.
This may be the best that any country can hope for in the near future. Cheng suggested political suicide be a widespread war with the single-payer healthcare industry.
"Our political system allows itself to be influenced by these interest groups and they are very powerful," Cheng said. "We in the United States have this birth defect and are left with it."
She said that regulating the market by paying all health care providers equally, regardless of coverage, and creating a social security option were good ideas. for California to build on what the state has already done.
California is already considering these options within the single-member Health Care Committee set up by Newsom and the state legislature this year. Experts say models that exist in other countries can drive a fairer, more efficient delivery system with less money.
It is expected that the Commission will begin its work in 2020, with the task of considering a way forward towards one-off payment and rigorous cost control mechanisms, including a global budgeting system that establishes a fixed amount of expenditure for health care for the state.
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Last year at unwritten moments during a bus tour through Los Angeles and California's Central Valley – Communities Home to California's Largest Uninsured Population – Newsom hints at the causes, due to which he predicted a slower path forward on a single-platter.
He said he observed various health care models used throughout the world, all of which included a major role for the government as a major payer for health care. The so-called Bismarck model used by Germany, Switzerland and Japan was the most attractive to California, he said.
Overall, it finances health coverage by jointly deducting employer-employee pay and retains the role of private physicians and hospitals. Some countries use one government payer, while others have multiple insurers, but this does not provide profits for health insurance companies and is all covered. A key feature is the rigorous cost control mechanisms regarding overall health care costs.
"Bismarck has more interesting principles than what we do in California," Newsom said last year.
He also analyzes other systems, including a socialized model of medicines, according to which the government owns hospitals, hires doctors, and pays for health care, as does education and public safety. And he studied traditional single-payment systems like those in Canada and Taiwan.