Pluralistic: 28 Jan 2022

Today's links

The state flag of California; the bear is wearing a scrub cap and procedure mask.

California's chance for universal health care (permalink)

"American exceptionalism" usually refers to Americans letting themselves off the hook for the sins they condemn in others (mass incarceration, death penalty, voter suppression, book burning, etc). But there's another kind of implicit exceptionalism, practiced by elites in service to the status quo: the belief that Americans are exceptionally stupid

Nowhere is this negative exceptionalism more obvious than in American health-care debates, where the cost of providing universal healthcare is presented as a bill that Americans cannot afford, without mentioning that Americans pay far more for private healthcare already, and that universal care would represent trillions in savings.

American private health-care is wildly inefficient. America pays more for care, and gets worse outcomes, than any other high-income nation in the world. America's private health care system is a bloated, bureaucratic, monopolistic mess. One in three US health-care dollars is spent on private administrative overheads – paper-pushers muddling through corporate red-tape.

And that's only the tip of the bureaucratic iceberg. US private health-care companies impose an even greater red-tape burden on their customers, who are drowning in useless paperwork. Take Cigna's four-page reimbursement form for covid tests, which has to be completed and either mailed or faxed (!) by patients every time they buy a $12 test.

America is a strange place. I'm six years into my fourth stint as a US resident, and I'm still figuring it out. Take American federalism: while "states' rights" is code for "Jim Crow," the states really are (or can be) "laboratories of democracy" – for better or for worse. California can export its tight emissions standards to the nation, while Texas can export its dismal textbook standards nationwide.

California (where I live) now has a credible shot at creating a universal care system, that, if successful, might be the counter to the negative exceptionalism that says that Americans are so innumerate that they can't grasp the difference between a cost and a net savings.

AB1400 is once again before the California legislature, having been reintroduced by Ash Kalra. The bill provides for free statewide care (CalCare), for citizens and immigrants (like me), including medical, dental, optical and mental health care.

The system is 100% free at the point of use: "no premiums, co-pays or deductibles." Hospitals and health-care providers would simply bill the state (which would negotiate fair prices) rather than insurance companies.

This is the second time that Kalra has introduced his bill. The first time, it failed due to objections about its costs. This time, the bill includes an amendment, ACA11, which sets out a funding mechanism:

Here's how it will be funded: a 2.3% tax on companies making $2m/year or more; a 1.25% payroll tax on companies with 50+ employees, and a 1% tax bump for individuals earning $49.9K-$149,509/year. Collectively, this will bring in the $314b needed to fund CalCare for every Californian.

Now, that number might seem like a big one, but as Sonali Kolhatkar writes for Naked Capitalism, it actually represents a savings for taxpayers, businesses and the state as a whole. For starters, the median Californian will pay $1,000 annually for CalCare, far less than even the cheapest health-care plan (and those cheap health-care plans cover far less than CalCare, and impose a far higher red-tape burden).

All told, Californians pay $391b/year for health care, and that's with 2.7m of us left completely without coverage. AB 1400 will zero out all that spending, and replace that system with a $314b universal program (with better benefits!) that will save the state and its residents a whopping $71,000,000,000 every single year, forever.

Who could possibly object to this system? You guessed it: the health insurance monopolists, who, with their allies in the California Chamber of Commerce, called AB 1400 "a job killer." This despite the fact that it will save companies – especially small businesses – a fortune in administrative overheads for health-care, while making their employees healthier and less precarious.

Far from being a job killer, AB 1400 will be a job creator, making it easier for employees to quit their jobs and start independent businesses without fear of medical bankruptcy, and removing barriers that prevent employees from quitting bad jobs and taking better ones for fear of losing access to the specialist health-care they or their family rely on.

For the Chamber of Commerce, the fact that employees can't quit bad jobs and start new businesses is a feature, not a bug. Tying health-care to employment creates leverage for employers over their employees, allowing them to suppress wages and silence complaints about toxic and dangerous workplaces. The Chamber doesn't represent all California businesses – it represents the state's oligarchic and monopolistic giants, for whom the administrative burden of health care is a small price to pay for a tame workforce and high barriers to entry for upstart competitors.

Naturally, the oligarchy lobby has allies in the press. The LA Times's George Skelton has a long history of simping for big business, and naturally he's weighed in to condemn CalCare with a textbook example of disingenuous negative American exceptionalism:

Skelton addresses his audience as if they were so innumerate that it's a wonder they can figure out how to buy a copy of the newspaper his column appears in. His objection to CalCare focuses entirely on the cost of providing it, without noting how much Californians are already paying for health care. He paints a $71b annual savings as a cost, and counts on his readers being too stupid to see this clumsy sleight of hand.

I'll stipulate that there is a sizable minority of Californians so ideologically opposed to the state provision of key services that they'll nod along with Skelton. It's even possible that these Bircher-come-latelies are reading the LA Times, possibly because all the pages of their copy of The Fountainhead are stuck together and they need some other way to while away the hours screaming at minimum-wage grocery-store clerks about mask requirements.

But these Californians are (thankfully) a minority. Californians overwhelming support a single-payer health care system.

And AB 1400 is progressing through the state legislature. On Jan 20, the Assembly Appropriations Committee passed the bill. Governor Gavin Newsom, his mandate just reaffirmed in a landslide during the recall election, campaigned on universal state health care.

But not all California Democrats are backing AB 1400, and Newsom is sending mixed signals about his support for the bill. This is a moment for Californians to show that they can do basic arithmetic, and can see through the ruse that pretends a $71b annual savings is actually a $314b cost.

This day in history (permalink)

#20yrsago Stephen King is out of ideas and is retiring from writing

#15yrsago Carl Malamud’s “10 Government Hacks”

#15yrsago Jonathan Lethem: remix my stories!

#10yrsago MPAA: "We're not comfortable with the internet"

#10yrsago WSJ’s partisan approach to climate change vs. science

#5yrsago China’s capital controls are working, and that’s bursting the global real-estate bubble

#1yrago Knowledge is why you build your own apps

#1yrago Understanding /r/wallstreetbets

#1yrago How apps steal your location

Colophon (permalink)

Today's top sources: Naked Capitalism (

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