Can Anyone Actually Do Anything to Bring Universal Health Insurance to California?

Tom Gallagher
5 min readFeb 7, 2022


The California Legislature has done it again — deep-sixed the single-payer health insurance bill for yet another session. All the big players in the California Democratic Party — and the party itself — claim they’re for it, and yet it somehow never happens. Lately the California Nurses Association has finally lost patience with Governor Gavin Newsom, whose gubernatorial campaign they enthusiastically embraced due to his claimed support of such a program, but who in four years has proven unwilling and/or unable to get it done. As San Francisco nears the end of a primary race for David Chiu’s now empty Assembly seat, a race in which candidates David Campos, Matt Haney, Bilal Mamood, and Thea Selby all profess support for the idea, we might well ask does it even matter? Can any of them plausibly make a case that they can and will make something happen, when Chiu, Tom Ammiano, and Mark Leno could not?

The story begins with the 1994 initiative campaign to supplant California’s private health insurance industry with an enhanced Medicaid For All-type, single-payer program operated on the state level. The initiative lost overwhelmingly, but it was a start.

Follow-up efforts brought a federally funded study which concluded that a state operated insurer could operate at substantially lower overhead cost than private health insurers — just as Medicare and Canadian provincial single-payer plans do. A bill to create the system followed in 2003; passed the Senate that year; but failed in the Assembly the next. Meanwhile Democratic Governor Gray Davis was recalled and replaced by movie star-turned-politician, Republican Arnold Schwarzenegger.

Where Davis had been uninvolved, Schwarzenegger was an outright opponent. When the legislature’s Democratic majorities signed, sealed, and delivered a bill creating a single payer system to his desk in 2006, he predictably vetoed it, declaring that “socialized medicine is not the solution to our state’s health care problems.” (The fact that the proposal was socialized insurance rather than socialized medicine is often seen as too fine a point for opponents, but it means doctors bill a single payer, rather dealing with multiple corporate insurance bureaucracies.)

The same scenario replayed two years later, and many hoped the anticipated election of Democratic Governor Jerry Brown might actually put the issue into play. The opposite happened. The Assembly did not send the bill to Schwarzenegger again, presumably so as not to force Brown into discussing the issue during his campaign. Universal health insurance was the sort of thing that the radical, out-of-office, We the People Jerry Brown would support, but not Governor-to-be Jerry Brown. And two years later, with Brown in office, the Democratic-controlled legislature again failed to pass the bill This time it was the Senate Democrats’ turn to play the heavy, so four of them abstained from voting on the bill, enough to allow Republican (plus two Democratic) votes to kill it. As a nurses union staffer of the time put it, “A Democratic legislature will pass single payer when there’s a Republican Governor but not when there’s a Democratic Governor — unless he wants it.”

Next, the legislation disappeared! In 2011, Democratic legislative leaders announced there would be no bill. Why? To give the federal Affordable Care Act, aka Obamacare, a chance to work. In its stead, there would be another study. They never said that a bill could not be filed. They can’t — the right to file belongs to the individual elected representative. Nevertheless, supporters could not persuade a single legislator to file, regardless of how supportive they were in the past. It was obviously clearly understood throughout the capitol that if you wished to accomplish anything of note you would not step over the line and file a single-payer bill. For the next four years the power to legislate on universal health care was effectively removed from the hands of California’s elected representatives. During Brown’s last term a bill was filed, but the Democratic majorities again did not pass it.

Meanwhile, almost every Democratic legislator professed support for single-payer legislation, yet all of them said there was nothing they could do about it. We might call the situation Kafkaesque, but since the state capitol looks more like something out of Disneyland than early twentieth century Prague, perhaps we should say the bill had been relegated to Fantasyland. When nurses flooded the room where California Democrats were holding their 2017 state convention raising chants of “Single-payer! Single-payer!” party chairman John Burton mocked them by chiming in, sing-song fashion, because, after all, we were all for single payer here, so what was the point of their chanting. Yes, we were all for it, but the people with the power to do something about it wouldn’t.

Which brings us back to the question of whether there’s actually anything a legislator — from AD 17 or elsewhere — could do to put an end to this nearly two- decade old cynical Sacramento shell game?

Perhaps an episode from the career of Massachusetts Senator Ed Markey might be of interest here. In 1976, Markey, the principal Senate Green New Deal sponsor who recently became the first person to defeat a Kennedy in a Massachusetts election, was a not terribly well-known 29 year-old congressional candidate in his second term as a member of the Massachusetts House of Representatives. He was considered, to put it mildly, not terribly influential. His lack of influence largely stemmed from having supported a bill eliminating part-time district judgeships that were generally considered patronage plums. Although House leadership opposed the bill, Markey’s side prevailed. In retaliation, the House Speaker not only threw him off the Judiciary Committee, but out of its office as well, moving his desk into the hallway.

Markey made the jump to the national level not by demonstrating his weight in the Massachusetts House, but rather by flaunting the lack thereof — in a TV commercial showing a desk in the hall with Markey saying, “They may tell me where to sit, but nobody tells me where to stand.”

The awesome power that legislative leaders wield in the shadows of state capitols may sometimes melt away in the glare of daylight. But someone may need to be willing to sit in the hall for awhile.