On Nov. 19, the Humboldt Progressive Democrats voted to admonish state Assemblyman Jim Wood for failing to “take steps to move forward” Senate Bill 562, the single-payer, universal healthcare bill for California that is currently stalled in the Assembly Rules Committee by order of Speaker Anthony Rendon. Wood has supported this suspension even while insisting he supports a single-payer system and is “not in opposition to S.B. 562.”
Emotions ran high at the meeting, expressed in passionate advocacy for and against Wood’s behavior. Still, the conflict is glaring and baffling: Why isn’t the bill being worked on to the satisfaction of that legislative body? Why was a “select committee” called to talk on and on about healthcare issues without mentioning this bill waiting to be addressed? There are even more of those meetings “planned” but, as yet, have no venue. What value will the meetings have unless expressed in legislation that already exists?
Earlier this fall, Wood enumerated several deficiencies in S.B. 562 that he felt warranted its shelving. They can be addressed as following:
First, he complains that rural areas will be underserved and doctors will not be incentivized to work in them. But once everyone, including rural folks, is truly covered by 562, there will be so much need for more doctors and clinics that caregivers will have plenty of work to do. Right now, rural clinics are closing because 90 percent of people who go there are poor patients who are minimally subsidized to the extent that caregivers come up short. If the playing field were leveled, caregivers would have as much incentive to work rurally as they do in the cities.
Second, Wood claims businesses are left out. In fact, under 562, businesses of all sizes will save by no longer paying employee health insurance or dealing with the morass of bureaucratic insurance tangles. Businesses would pay a proposed 2.3 percent gross receipts fee, with the first $2 million exempted. A sales tax increase of 2.3 percent would cover the rest of the cost of universally supplying high-quality healthcare, with our poorest citizens receiving a tax rebate to ease that burden. The sales tax would be more than offset by the huge savings from no more premiums, deductibles or co-pays.
This also answers Wood’s concern that there is no funding mechanism in the bill. The non-partisan, 90-page Pollin Report from the University of Massachusetts has determined that this program will not only cover every resident but will save the state $39 billion. Sound far-fetched? When you cut out the middleman (corporate insurance profit, marketing, overhead, etc.), negotiate and control pharmaceutical cost, “far-fetched” will happen! Put it in the bill!
Third, Wood opines that elders would look askance at having Medicare folded into this system. Medicare as we know it has many flaws, which Wood enumerates as positive elements. Namely, besides various co-pays, 20 percent of caregiver costs must be paid for either by the elder or by purchasing private insurance coverage. Medicare today does not cover vision, dentistry or hearing — which older folks so often need. The subsequent devastating costs result in one out of four seniors going bankrupt. I submit that elders would love to have their existing Medicare folded into this system!
Fourth, Mr. Wood is correct in noting there may be a challenge to obtaining waivers from the federal government to retain our current levels of subsidy. However, current law provides that, for any state that discovers a means to more economically provide healthcare than through the ACA, subsidies cannot be withheld. Further, there are various other legal remedies and precedents to rebut such unilateral withholding.
Additionally, these objections, even if true, should not condemn S.B. 562 to oblivion. The job of the Legislature is to build and perfect a bill as it works its way through passage.
Mr. Wood, you have earned an “admonishment” from many of your former supporters. This is not censure but encouragement to do better. We have a bill on the table that is a blueprint to solve our desperate healthcare problems. Why won’t you put the rubber on the road so we can activate that program instead of endless talk about alternative possibilities, already shown to be inadequate? Why aren’t you working to improve the bill to meet all necessary standards? You have said proponents are “stuck on the idea of S.B. 562.” It is not just an idea; it is a way forward. We recall the words of Everett Dirksen when he admitted, “When I feel the heat, I see the Light!” Mr. Wood, we hope this admonishment will warm you up. People are going bankrupt, losing their homes and dying. It’s urgent. Let’s work on it!
Patty Harvey lives in Willow Creek, is a retired teacher and current director of Health Care for All-Humboldt. She has been a Humboldt County resident off and on for more than five decades.
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I have heard that S.B. 562 includes provisions having the system turned over to one private managed care company, i.e. an insurance company. I’d like to find out if this is true. Kaiser comes to mind. CA can create a model for the country. I would hate it to be with the expensive, unproven, unaccountable MCO model.
Where did you hear this? That is simply untrue. The system would be run by a non-profit entity of the State of CA–starting at the top with a board of 9 appointed by various members of our legislators whose behavior would be subject to approval, ultimately, by voters. The savings by cutting out profit alone would be tremendous, not to mention savings from no advertising, administrative costs both by the paying bodies and the paid; i.e., doctors, clinics, hospitals who waste millions deciphering the red tape of insurance and battling the profit motive that decrees as little benefit as possible may be paid.
Feedback from an expert:
On Dec 7, 2017, at 2:44 PM, Kip wrote:
You should tell the reader to look at two documents: The q and a document on SB 562 prepared by Healthy California; and the Lewin Group’s analysis of the first “single payer” bill introduced in CA in 2003.
The q and a document on 562 is here http://www.healthycaliforniaact.org/wp-content/uploads/SB-562-QA-Flyer.pdf . At page 6 you read this question: “Is there a role for Kaiser Permanente and other integrated health systems?” The answer given is: “Yes. Healthy California members can choose to enroll with … HMOs, including Kaiser Permanente.”
The Lewin document is here http://www.pnhp.org/sites/default/files/docs/2010/Health-care-for-all-Californians-acts-Lewin-2005.pdf . It reviews SB 921, the predecessor to 562 introduced by Senator Shiela Kuehl in 2003. 562 is different in some ways from 921, but not in the basic multi-HMO structure that Californians will live under if 562 is enacted. 921 used the same circular, flabby definition of “integrated delivery system” 562 uses, namely:
“Integrated health care delivery system” means a provider organization that meets all of the following criteria:
(1) Is fully integrated operationally and clinically to provide a broad range of health-care services, including preventative care, prenatal and well-baby care, immunizations, screening diagnostics, emergency services, hospital and medical services, surgical services, and ancillary services.
(2) Is compensated using capitation or facility budgets, except for copayments, for the provision of health care services.
Here is how Lewin describes the “single payer” system under 921 in their 2005 report, The Health Care For All Californians Act….
People would have the choice of selecting their own primary provider or being covered through an HMO or other integrated delivery system that would be paid a risk adjusted amount to cover all costs for enrollees. [p 2]
HMO Coverage Option
Beneficiaries would have the option of selecting their own primary provider or enrolling in integrated delivery system models such as Health Maintenance Organizations (HMO). The following would apply:
People are generally assumed to be required to remain in the plan for a year. However, there is a three month trial period in which patients may disenroll for any reason. They may also disenroll at any time if the health plan can not provide needed care. In addition, patients may appeal to the Consumer Advocate (created under the program) for early disenrollment, that would be provided if deemed warranted; and Payments to the plan would be risk-adjusted and calibrated so that enrollment in HMOs is budget neutral to the Act. For example, if the HMO for some reason enrolls a disproportionate share of older people, the amount of money needed to provide the services they require would on average be substantially greater than the cost of care for those who do not join the HMO (who are disproportionately younger). Thus, in this example, we would assume that the payments to the HMO are adjusted to reflect the higher cost of caring for those who enroll in the HMO. Payment adjustments of this type are to avoid either under-funding or over-funding care for HMOs…. [pages 6-7]
It doesn’t get much more obvious than this.
I don’t agree with everything Lewin says about real and bogus single-payer bills, including what it said about 921. But their characterization of “IDS” as just another word for “HMO” is accurate.
Kip