California’s next governor, whoever it is, needs to have a dose of fiscal realism.
At a Nov. 7 candidate forum host at UC Riverside, former Los Angeles Mayor Antonio Villaraigosa was the only one of the Democratic candidates to oppose establishing a single-payer health system at the state level.
The idea was supported by three Democratic candidates in attendance: State Supt. of Public Instruction Tony Thurmond, former Controller Betty Yee and former U.S. Secretary of Health and Human Services Xavier Becerra. Although not in attendance at the UC Riverside forum, at a candidate forum in September former Rep. Katie Porter notably did not raise her hand when asked about supporting single-payer.
Over the past two decades, various single-payer bills have been advanced in the Legislature, the last being Assembly Bill 2200 in 2024, by Assemblymember Ash Kalra, D-San Jose. It was called the California Guaranteed Health Care for All Act, or CalCare. An Assembly Appropriations Committee analysis, citing estimates for previous similar bills, reported yearly costs “equivalent to $392 billion in 2024 dollars.” By itself that would be more than the entire $228 billion general-fund budget for the 2025-26 fiscal year passed last summer.
“There’s no way single-payer could be affordable in California,” Sally Pipes told us; she’s the President of the Pacific Research Institute and the author of several books on health care, including this year’s “The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy – and How to Keep It.”
“The worst thing is patients would have to wait in long lines for rationed care,” she warned. “The best doctors also would leave California for other states that don’t have single-payer. That way they could make a decent living practicing the kind of medicine they want to, and get their patients the medicines and appointments for treatment that are needed.”
At the UC Riverside forum, Villaraigosa acknowledged the need to make health care more affordable. But as a former Assembly speaker well-versed in passing state budgets, he said, “Next year, we’re looking at anywhere from $12 to $20 billion worth of deficits, and so the next governor is going to have to really balance a whole lot.” Indeed, that deficit problem, and how Newsom and the Legislature deal with it, will grind through next year as the gubernatorial race picks up.
It’s a point shared by Porter at the September forum, who favors single-payer at the federal level. “I’ve always championed it at the federal level,” she said. “I don’t think it’s realistic in the next couple of years for the state to push forward on that.”
Their support for single-payer at the state level, given the existing realities, should be disqualifying for the others. It’s not surprising Yee has problems with budgets as, when controller, she was habitually late turning in state fiscal statements. Thurmond has presided over dismal state student test results and has oddly chosen to run on a record of failure. Becerra ought to have better fiscal sense as someone who oversaw a massive federal bureaucracy.
We’ll continue monitoring candidate forums as the campaign matures. But the first qualification ought to be not selling the voters fiscal snake oil.