What is Medicare for All Californians


A Medicare for All financed health care is a cost-effective method for financing and administering a universal health system.

With a Medicare for All system California would establish a health plan that covers all residents. The plan replaces all health insurance plans, both public and private.

The plan is administered by a single State Health Agency with local branches.

The plan is financed by state health taxes and federal money that now goes to health care, such as Medicare, MediCal and Federal subsidies in Obamacare.

All money earmarked for health care would go into a single state health trust fund.

Consolidation of administration and finance would save billions of dollars. Cost of administration would drop from 25%-35% of health spending to 3-5%.


The state would become the single purchaser of pharmaceuticals and durable medical equipment. It would use its bulk purchasing power to lower costs up to 50% by purchasing from the Federal Supply Schedule. This would save billions. The state would coordinate capital expenditures. This would also save billions.

Everyone would have a doctor and receive preventive care. This would save billions. The saved dollars would be used to provide health care.

A public planning process would determine how we would spend our health care dollars and it would control growth in spending through global health budgets.

Quality of care would be improved through equitable distribution of resources, choice of physician, primary and preventive care, risk adjusted budgets that pay the true costs of care, statewide data collection and analysis, public access to non-confidential data, linkage of health research and innovation to actual health care needs, safe staffing ratios, return of medical decision making to medical providers and patients, use of evidence-based medical practices and monitoring of outcomes, funded consumer advocates and monitoring of consumer and provider satisfaction.

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A health care tax would replace all health insurance premiums, all deductibles and most other out of pocket health expenses, including most co-pays.

The benefits received with payment of the health tax would exceed those of most all existing private insurance plans. There would be no exclusions for “pre-existing conditions” or any other health problems. Dental care, mental health parity, long term care, alternative and complementary care, durable medical equipment and full prescription drug coverage would be included without co-pays.

The health care tax would be less than current health insurance premiums for most individuals and for all employers who currently provide health coverage.

95%-98% of the health care tax would go directly to health care services, whereas only 75-80% of health insurance premiums currently go toward paying for health care services.

The health tax would be equitably structured so what each person pays what is affordable, based upon ability to pay.

Since the health tax would less than insurance premiums that employers now pay, the difference could provide a pool of dollars that unions could negotiate back into wages and other benefits.

No new spending would be associated to the change. Instead, a shifting of funds from the private sector (insurance premiums) to the public sector (health tax) would take place along with all current federal and state healthcare funding for Californians from Medicare, Medical and the Affordable Care Act subsidies.

The health tax would be socially responsible:  tax proceeds would be used to assure that all Californians receive an essential social service.  Health insurance premiums are socially irresponsible:  proceeds are used to assure profitability to the health insurance industry and its shareholders and an essential service is provided only to those who can afford it.

Californians and most of their legislators are smart enough to understand that a not-for-profit health care system with a universal risk pool financed by taxes would be a more cost effective, stable system than one made up of fragmented risk pools, each burdened with an expensive bureaucracy and profit-sharing requirements.

Californians and most of their legislators are smart enough to understand that the health tax is a good deal, a better deal than insurance premiums. The health tax is like the Medicare tax only better:  it provides lifelong health care security for all of us.


The most recent financial analysis of a California Medicare for All type health care system, The Lewin Report, was done in 2005. Since that time, and because California failed to pass that system into law, the cost of health care in our state has risen.

California OneCare and several other organizations are working to raise funds for a current financial analysis of a Medicare for All system in California. What we do know is that the United States, while leaving many of its citizens without adequate health care, pays twice as much per capita as all other developed nations which provide full health care to all of their citizens.

Although the numbers will differ in any updated financial analysis, a reading of the 2005 Lewin Report Summary will provide you with an understanding of how the implementation of a Medicare for All system (single payer) in California can be financed. (Download a copy of this document: Lewin Summary )

In-Depth Q&A

What is a Medicare for All health care system?

Medicare for All would provide for a single payer type universal health care system that is financed and administered by the state. It will replace California’s current system of multiple public and private insurers, which excludes nearly 3.8 million Californians under the age of 65 from health coverage. The health care system would provide all residents with comprehensive health care regardless of their age, health or employment status. While controlling health care costs, the state pays for all health care charges for care provided to residents by private doctors, hospitals, clinics, pharmacies and other providers that continue to operate as independent entities.

This health care system is not socialized health care because the state will not run the health care delivery system. Instead, it will manage how the system is financed and provide coverage for all residents based on a single standard of care for everyone.

This publicly financed health care system replaces most current government funded health programs and hundreds of private insurance companies that administer thousands of different policies. These private insurers waste health care dollars on excessive and inefficient spending on health care administration instead of providing needed health care.

The Lewin Group, a premier national health care and human services consulting firm with more than 35 years providing analytical services for public, non-profit and private sectors, finds that several single payer financing models similar to Medicare for All reduce costs significantly enough to provide a basis for Medicare for All system to cover all Californians.

This document was researched and written by the League of Women Voters of California (Download the complete 20 page document here: In-Depth Q&A).