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What is Single Payer?
In-Depth Q&A
California Universal Health Care Act (SB 810)
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What is Single Payer?


Single payer financed health care is a cost-effective method for financing and administering a universal health system.

With a single payer system California establishes 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 and MediCal.

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

Consolidation of administration and finance saves billions of dollars. Cost of administration drops from 25%-35% of health spending to 2-3%.

The state becomes the single purchaser of pharmaceuticals and durable medical equipment. It uses bulk purchasing power to lower costs up to 50% by purchasing from the Federal Supply Schedule. This saves billions. The state coordinates capital expenditures. This also saves billions.

Everyone has a doctor and gets preventive care. This saves billions. Saved dollars are shifted into health care.

The public planning process determines how we spend our health care dollars and controls growth in spending through global health budgets.

Quality of care is 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 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.


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

When you pay the health tax, the benefits you get are better than any existing health insurance plan and there are 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 are included without co-pays.

The health care tax is 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 goes directly to health care services, whereas only 65%-75% of health insurance premiums go to health care services.

The health tax is equitably structured so what each person pays is affordable. Health insurance premiums bear no relationship to one’s ability to pay.

The health tax is less than insurance premiums employers now pay so there is a pool of dollars that unions can negotiate back into wages and other benefits.

The health tax involves no new spending. Instead, it involves a shift of funds from the private sector (insurance premiums) to the public sector (health tax).

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

Californians and their legislators are smart enough to understand that a not-for-profit health care system with a universal risk pool financed by taxes is 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 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.

(used with permission from Health Care for All – California)



The most recent financial analysis of California’s single payer health care legislation, The Lewin Report, was done in 2005. Since that time, and because California failed to pass single payer into law, the cost of health care in our state has risen.

Without those numbers it is not possible to say precisely how SB 810 will be financed nor exactly what the cost will be for individuals and businesses. Consequently, no finance bill has been written to accompany SB 810 in the 2009-2011 legislative sessions.

California OneCare and several other organizations are working to raise funds for a current financial analysis of SB 810. 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 of SB 810, a reading of the 2005 Lewin Report Summary will provide you with an understanding of how the implementation of a single payer system in California can be financed. (Download a copy of this document: Lewin Summary )


In-Depth Q&A

What is a single payer universal health care system?

SB 810 (Leno) provides for a single payer 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 6.6 million Californians from health coverage.[1] The health care system provides 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 SB 810 reduce costs significantly enough to provide a basis for single payer universal health care for all Californians.[2]

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).


BILL NUMBER : S.B. No. 810
TOPIC : Single-payer health care coverage.

Bill History 2011

Feb. 18 Introduced. Read first time. To Committee on RULES. for assignment. To print.

Feb. 20 From printer. May be acted upon on or after March 22.

Mar. 10 Referred to Committees on HEALTH and RULES.

Mar. 31 Set for hearing April 27.

Apr. 25 Set, first hearing. Hearing canceled at the request of author.

Apr. 26 Set for hearing May 4.

May 9 From committee: Do pass as amended and re-refer to Committee on APPROPRIATIONS. (Ayes 5. Noes 3. Page 886.) (May 4).

May 11 Withdrawn from committee. Re-referred to Committee on RULES. May 10 Read second time and amended. Re-referred to Committee on APPROPRIATIONS.

May 19 Re-referred to Committee on APPROPRIATIONS.

May 20 Set for hearing May 23.

May 23 Set, first hearing. Hearing canceled at the request of author.


SB 810, as amended, Leno. Single-payer health care coverage.

Existing law does not provide a system of universal health care coverage for California residents. Existing law provides for the creation of various programs to provide health care services to persons who have limited incomes and meet various eligibility requirements. These programs include the Healthy Families Program administered by the Managed Risk Medical Insurance Board, and the Medi-Cal program administered by the State Department of Health Care Services. Existing law provides for the regulation of health care service plans by the Department of Managed Health Care and health insurers by the Department of Insurance. Existing law establishes the California Health Benefit Exchange to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January, 1, 2014.

This bill would establish the California Healthcare System to be administered by the newly created California Healthcare Agency under the control of a Healthcare Commissioner appointed by the Governor and subject to confirmation by the Senate. The bill would make all California residents eligible for specified health care benefits under the California Healthcare System, which would, on a single-payer basis, negotiate for or set fees for health care services provided through the system and pay claims for those services. The bill would require the commissioner to seek all necessary waivers, exemptions, agreements, or legislation to allow various existing federal, state, and local health care payments to be paid to the California Healthcare System, which would then assume responsibility for all benefits and services previously paid for with those funds. (To view SB 810 in its entirety click here.)