The Fight Within the Democratic Party Over California Universal Health Insurance Plan
Michael Lighty of National Nurses United tells Paul Jay how the California Senate passed the “Healthy California” plan and the coming battle to make it into law
Paul Jay: Welcome to The Real News Network. I’m Paul Jay. We’re at the People’s Summit in Chicago. The driving force of the Summit has been the National Nurses Union. They’ve been also leading the fight in California for what they’re calling Healthy California. It’s essentially a California Medicare for All or government health insurance plan, where everybody’s in and nobody’s out.
Now joining me is one of the people from the Nurses Union, who’s been at the leading front of all of this, and that’s Michael Lighty. Michael is the Director of Public Policy for National Nurses United. Thanks for joining me again.
Michael Lighty: Thank you, Paul.
Paul Jay: The fight for this government health insurance plan, Medicare for All, whatever we’re gonna call it, has been a fight to a large extent against corporate Democrats. You’re fighting within the Democratic Party to get it. You’ve now been able to pass it at the Senate, but even that was a major battle. In fact, talk a bit about how you were able to get that through the Senate.
Michael Lighty: Well, it is a fight within the Democratic Party in a sense that in California they have two thirds of the legislature, two thirds of the Senate, two thirds of the Assembly, and a Democratic governor. The political question for them is, “Are you gonna let the Trump administration define what kind of healthcare Californians get?” Democrats do not want to say yes to that. They obviously don’t want millions of Californians to lose the coverage they have, though it’s not as good as it could be. Nor do they want to lose the billions of dollars that are currently funding healthcare in California through the Affordable Care Act, that the Republicans would take away if they succeed.
That context sharpens the debate because there has to be an alternative to Ryan Care, Trump Care, if Californians are gonna maintain their ability to even have what we have now. Our argument has been you can’t plug that hole. That’s not politically viable to simply ask Californians who have insurance to pay for those who lose it because of the Republican’s actions. You’ve got to guarantee healthcare for all in California.
Now the opposition says, “Well, it’s not viable at the state level. How are you gonna pay for it? We’ve got these issues.” You will not find Democrats who say, “I’m opposed to a Medicare-for-All type system in California.” “I just don’t know if this is the right time. I don’t if it’s viable. I want to see what happens at the federal level.” Those are all excuses.
Paul Jay: Isn’t there something kind of like it already in San Francisco?
Michael Lighty: Well, there is-
Paul Jay: In the city?
Michael Lighty: There is Healthy San Francisco and it’s an interesting variant because what they do is they tax employers to provide funding for access to the public health system. San Francisco has a very robust public health system, clinics, community clinics, and a great hospital, San Francisco General Hospital. Anyone who’s uncovered in California, who falls through the cracks from the Affordable Care Act, is undocumented, or can’t otherwise afford the coverage there, they’re able to access the public health system in California as a matter of right.
Paul Jay: In San Francisco.
Michael Lighty: In San Francisco. San Francisco residents again, it’s the parallel, right? So that is a good model, but it’s not exactly what we’re doing at the state level.
Paul Jay: Describe the model and, again, what’s the critique why it isn’t viable. What exactly is the model?
Michael Lighty: Well, the model is essentially get rid of the private insurance companies, replace the portion of financing that is currently privately done through the private insurance companies, where they rake in five billion a year among them as net income, and instead replace those premiums, deductibles and copays with a broad progressive financing program that guarantees healthcare for all as a right. That’s the policy.
This is where we need to start the debate. The debate shouldn’t be about financing or viability first. The debate should be about guaranteeing healthcare for all, putting providers, clinicians, caregivers in charge. Guaranteeing comprehensive benefits and complete access and choice of any provider you want.
Now those policies are what’s driving our debate. The politics that are driving it is the fact so many Californians … We estimate 36% of Californians are under insured. They have a deductible more than $2,000 a year, and they literally can’t afford to get the care that they need. Then prescription drug prices, obviously, escalating premiums, all those are driving the politics of it. Ultimately Democrats face that choice.
Paul Jay: I would guess corporate Democrats would agree with everything you just said except the first sentence, which was you just went like that, “Get rid of the private insurance companies.”
Michael Lighty: That’s right.
Paul Jay: Except the private insurance companies are, I assume, funding a lot of the political campaigns of the Democrats that are sitting in seats right now.
Michael Lighty: That’s what funny, Paul, is that we have the state Senator who voted for the bill whose list of donors is the entire healthcare industry from pharma to hospitals to insurance companies-
Paul Jay: How did you get this through the Senate?
Michael Lighty: … and he voted for the bill. Inside, outside, you know, we have a very good relationship with the Capitol. We try to play the inside game-
Paul Jay: In the Capitol.
Michael Lighty: In the Capitol.
Paul Jay: Not with Capitol.
Michael Lighty: Not with the … Thank you, in the Capitol. We put forward the policy. We made a strong case, but ultimately, we mobilized this grassroots army coming right out of the Senator Sanders’ campaign. Our revolution, what we call the A Demmers, those who took over the grassroots delegates at the California Democrat Party. We took all this … and then all the folks who’ve been working on this type of reform for really decades, since back in the 1990s, Health Care for all California. Obviously, it’s California Nurses Association, we’re in the lead. You’ve got a nurses’ campaign with all these broad allies, the millennials who came up through Bernie’s campaign, who are devoting themselves to this issue of Medicare for All at the national level. All of that grassroots pressure basically convinced the Democrats that their political future depended on pushing this reform and voting for it. Had they stopped it in the Senate, the impact, politically, would have been devastating to those.
Paul Jay: What’s it look like for the Assembly?
Michael Lighty: I think the political calculation’s very similar. We also have to get the policy right. There’s some still work to be done on the bill. The politics of this are shaped by the reality that the California Democrats are either gonna be responsible for the changes that the GOP do at the federal level, or they’re gonna come up with an alternative. This is the only viable alternative.
Paul Jay: Then it comes down the Governor, if you get to the Assembly.
Michael Lighty: Right.
Paul Jay: Do you think he’ll sign this?
Michael Lighty: We believe he will. We believe that this is good for his legacy. We believe that we will prove to him that it is viable financially. We will prove to him that he can actually establish a standard for guaranteed healthcare for all that will within, I think, a number of years be the federal standard.
Paul Jay: What’s the argument against the viability? California is about the same size as Canada. There’s a system in Canada with that many people. I mean, California is a country.
Michael Lighty: Well, it’s ironic, of course, because I hear the California governor go around telling everyone that we can engage on climate like a nation, that we can lead nations on climate, that we have the resources of a nation when it comes to dealing with these issues. I believe that’s true of healthcare too.
Paul Jay: Well, we were talking a little bit off camera about some of the critique. Couldn’t this bill have been stronger, the bill you helped write the bill as well. Your response was, “But there’s structural reasons, not just political reasons.” But why? What are the structural issues?
Michael Lighty: Well, you’ve got 70% of personal healthcare expenses in California are paid by tax dollars. Most of those tax dollars are Federal. For example, employers in California who buy insurance get a tax break worth $53 billion a year. Individuals get a tax break worth about 33 billion. The federal government is paying, I think in Medicare it’s about 78 billion, and in Medicaid it’s around 63-64 billion, if I have those numbers right. You can see that’s a massive amount of money. Overall, about 225 billion, in our estimate, is from the Federal government. We’re talking about a program that, in our analysis, costs about 331 billion. Right now, you’re looking at a huge federal contribution that we have to capture for Healthy California.
Then, of course, you’ve got other federal employee programs, both for the military and other government workers. You’ve got federal drug pricing policy that presumably controls, not entirely, but it’s still primarily a federally controlled industry, right, the pharmaceutical industry. You have these real structural constraints in a federal system where money and regulatory authority resides at the federal level.
We have an approach that overcomes those. In fact, the Affordable Care Act provides for waivers to states who set up universal healthcare programs that are either budget neutral and improve access. Obviously, we meet that criteria because we save money and cover everybody. We believe that there is a strong basis for being able to create, where we channel all this money into one pot, and then be able to pay providers in a way that’s much more cost effective and saves taxpayers money. That’s really what it comes down to.
Paul Jay: You need the federal government to agree to this transfer.
Michael Lighty: Exactly, we need the feds to agree.
Paul Jay: If they don’t agree, is there discussion of some kind of a wealth tax, or estate tax. Seems to me that the cost of what you’re saying 300 and some odd billion dollars is maybe, I don’t know, five or six square blocks of Bel Air or Malibu? I mean, if you had a wealth estate tax-
Michael Lighty: You’re probably right about that.
Paul Jay: … you would pay this off relatively easily here. Not every state has the kind of money California does, but …
Michael Lighty: No, that’s true. That’s true. Yeah, and we’ve raised taxes on upper income folks. We passed, in fact the Governor supported it, you know, initially an upper income tax. That is a viable strategy, but when you have to raise the money that we have to raise for this program, it’s not enough. You’re right. If, in fact, the federal GOP bill passes … Really just a tax cut for the wealthy anyway, so you’d want to capture that money … that couldn’t fully fund our program. We’re replacing private insurance premiums, deductibles and copays. We’re relieving businesses of a huge burden.
The irony to me, Paul, is that Charlie Munger, who’s the co-chair of Berkshire Hathaway, came out for Medicare for All. He’s the largest GOP donor in California.
Paul Jay: Well, in Canada, one of the biggest supporters of the government health insurance was General Motors.
Michael Lighty: Exactly.
Paul Jay: In fact, it was one of things that spurred more auto production in Canada versus the US because of the cost of-
Michael Lighty: Don’t tell-
Paul Jay: Healthcare was so much less.
Michael Lighty: Don’t tell the Americans.
Paul Jay: All right, well, so what’s the big moment for this fight?
Michael Lighty: Well, we got to get … We’re over in the Assembly. We passed the Senate 23-14. When we say the Democrats didn’t, all of them didn’t vote for it, they stayed off the bill. One voted no, anti-labor Democrat from Contra Costa County. We’ve got to now go to the Assembly and move it through the Health Committee and their Financing Committee, and then onto the floor with the financing plan in it. That will take 54 votes, two thirds of the California Assembly. Goes back to the Senate for concurrence. Then onto-
Paul Jay: Do you have any idea when that vote might be happening?
Michael Lighty: It has to be held by September 1st.
Paul Jay: Oh, so not that far away.
Michael Lighty: Yeah.
Paul Jay: All right, we’ll stay on this story. Thanks very much.
Michael Lighty: Thanks a lot.
Paul Jay: Thank you for joining us on The Real News Network.