Malleability of single payer support

Californians & Their Government

By Mark Baldassare, Dean Bonner, Alyssa Dykman
Public Policy Institute of California, May 2018

Health Care Policy

A single-payer state health insurance program is now under discussion. Senate Bill 562, which would establish such a program, passed in the senate last year and is currently held in the state assembly. How do Californians feel about this idea today? A majority of adults (64%) and likely voters (53%) favor a single-payer state plan. However, if this plan requires raising taxes, support declines (41% adults still favor, 41% likely voters still favor). Similar shares of adults and likely voters held this view last May. An overwhelming majority of Democrats (78%) favor a single-payer state system—including 62 percent even if it means raising taxes—while a strong majority of Republicans (67%) are opposed. A majority of independents (55%) are in favor, while 36 percent are opposed. Majorities across demographic groups favor a single-payer system, but if raising taxes is required, support falls below 50 percent for all groups—with the exception of college graduates (51%).

Q: “Do you favor or oppose having guaranteed health insurance coverage in which all Californians would get their insurance through a single state government health plan? (If favor: Do you favor it even if it means raising taxes?)”

64% - Favor
41% - Favor, even if it means raising taxes
23% - Favor, not if it means raising taxes
29% - Oppose
7% - Don't know

Full report:



By Don McCanne, M.D.

A single payer, improved Medicare for all program would be vastly superior to our current method of financing health care (even with the Affordable Care Act), and 64 percent of California adults favor "a single state government health plan." However, significant partisan opposition persists, and even support is malleable, dropping to 41 percent when those favoring are asked "even if it means raising taxes."

The malleability of support is important. Since no state government has been successful in both enacting and implementing a state single payer system, it has been suggested repeatedly that it should be submitted to the voters as a ballot measure. However that has already been tried in California, Oregon, and Colorado where the measures were defeated by overwhelming margins (3 to 1 or 4 to 1) since the voters proved to be very sensitive to the anti-government, anti-tax rhetoric of the opponents.

The Vermont legislature did enact what began as a single payer proposal but which was later modified because of conflicts with existing federal programs, but even the modified version was abandoned when implementation proved to be too difficult.

Many say that we should continue to push for a state single payer system to serve as an example for the nation, just as Saskatchewan served as an example for Canada that eventually led to single payer systems in all provinces. A major hurdle to that approach is that federal programs are already in place in the United States that would require comprehensive federal legislation to modify regulations and free up federal funds for use by the states. Of course there are valiant efforts in states such as New York (Gottfried) and Minnesota (Marty) to work around these federal limitations and restrictions, so we do not need to give up entirely on state efforts as transitional programs that can provide relief until we can achieve the goal of a national program for all.

What lessons can our Medicare and Canada's Medicare provide for us? Both were accomplished through federal congressional or parliamentary acts. The people elected representatives who were supportive of Medicare (though the political process limited ours to those with the greatest needs - Medicare for seniors and Medicaid for the poor), and then the representatives enacted the programs.

We can do that again. We do need to increase our efforts at educating the public. When people hear "more taxes for health care" they need to immediately think "but a much fairer way of paying for health care for all of us." When they hear that the government can't do anything right, they need to remind themselves how relieved they were when they finally qualified for the government Medicare program.

If the people lead, the politicians will follow. This poll shows 64 percent support for single payer, and other polls have shown that the support is especially great when Medicare is invoked (again, malleability). We are getting there. We just need to step up our efforts to educate and activate as we head up this path toward health care justice for all.

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