California Debates Healthcare

By Blake Plante (PO ’19)

On Sunday October 22, the four Democratic candidates for the California gubernatorial race met in front of the National Union of Healthcare Workers (NUHW) for a substantive debate that explored single-payer/universal health care plans, the opioid crisis, mental health policy, right to work laws, sanctuary cities, how to gain bipartisan support, and aging in the American workforce. After the debate, the NUHW spent the day deliberating and chose to endorse current Lieutenant Governor and former mayor of San Francisco Gavin Newsom. The endorsement puts 11,000 California healthcare workers behind Newsom and indicates growing enthusiasm for the candidate, who had also received the endorsement of the California Teachers Association on Saturday and the California Nurses Union last December. Moreover, the debate itself is illustrative of a debate between political candidates done well, and contained numerous clashes that will anticipate future healthcare debates within the Democratic Party on the national level.

The format was uniquely strict for a political debate, more closely resembling the cross-examining rigor of a presidential debate format proposed in Aaron Sorkin’s The Newsroom than last year’s presidential debates. The moderator, John Donvan—host and moderator of the Intelligence Squared U.S. debates—does not shy away from holding speakers accountable for their statements and requiring them to answer every question they were asked. Donvan, members from the union, and a panel of journalists had the opportunity to ask the candidates specifically-directed and follow-up questions in seven rounds of questioning. The candidates cooperated and excelled in the format, making no personal attacks and even supporting each other. At one point, Gavin Newsom interrupted himself to let Villaraigosa speak instead, and at another, Villaraigosa defended Newsom against the moderator for pivoting “off topic” to the Napa fire on a question asked by a union member from Napa.

In a surprising run-off vote between Gavin Newsom and Delaine Eastin, widely considered the underdog candidate because she has been out of public office since 2003, Newsom won the endorsement with 53% of the vote. Delaine Eastin is a former California State Assembly member, Superintendent of Public Instruction and professor, and makes education the centerpiece of her campaign. Antonio Villaraigosa, currently trailing behind Newsom in polls, was the 41st mayor of Los Angeles, and separated from the other candidates on single-payer healthcare. John Chiang is the current California State Treasurer. Republican candidates John Cox and Travis Allen were not present, though NUHW President Sal Rosselli stated that they had been invited.

Newsom won over the NUHW audience with optimism for SB 562, California’s single-payer health care legislation that served as a model for the Sanders plan. Senate Bill 562 was shelved by Assembly Speaker Anthony Rendon in June, citing its lack of a financial mechanism, but support for single-payer healthcare has nevertheless become a litmus test for the Democratic candidates. Chiang, Eastin, and Newsom all expressed enthusiasm for such a plan, though Villaraigosa remained speculative that it could be achieved in the short term, and suggested creating “a public option that would allow people to buy into Medicare.” Newsom had already implemented a universal healthcare plan as mayor of San Francisco, and when asked how he would propose paying for a statewide plan, he responded:

“I think there’s a lot of mythology about the cost of single-payer—that somehow we’re adding on top of an existing multi-payer system, when in fact it is about reallocating existing resources and using them more effectively and efficiently by replacing the current multi-payer system.” Newsom proceeded, listing off numbers and context as he was wont to do throughout the debate. “The fact is we’re already spending $367.5 billion a year because of health care according to UCLA [Center for Health Policy Research] in this state, 70% of it borne by the taxpayers. A single-payer system drives down the cost of health care, drives down the cost of prescription drugs through economies of scale, and provides a more effective, efficient, and universal access for those who are uninsured. You have 3 million people in the state of California without health insurance… millions of others have seen double-digit increases over the course of the last few years in their premiums. Single-payer is the way to go to reduce cost and provide comprehensive access.”

On mental health, all candidates agreed that more resources are needed, with Newsom citing Prop 64, his Marijuana Bill that sets aside billions of dollars over the next few decades for behavioral health and substance abuse. All candidates were also opposed to Right to Work laws, agreeing to use the tenth amendment of the U.S. Constitution to make sure the state protects Californian unions, and expressing the importance of collective bargaining. Newsom argued that central to bipartisan support is the success of labor.

“I think at the end of the day you can’t live a good life in an unjust society. There’s no leak on your side of our boat. If you want to go fast, you can go alone. But if you want to go far as a state and a country, you have to go together. And so this notion of interdependence… your business cannot thrive in a world that’s failing. And unless we deal with the issues of social mobility, income inequality, wealth inequality in a meaningful way, look, we live in the richest and the poorest state in America. 8 million people below the poverty line, 24% in the supplemental poverty index… The 26 counties that went for Donald Trump—look at the concentration of poverty in those counties. Look at the counties that are not being represented, that could be represented by working folks that are organized in unions like yours whose wages and prosperity could be substantially improved and increased. Labor is the key to the middle class; it’s a key to so many of the challenges we face today.”

All the candidates supported increased investment in DACA and protection of immigrants. “We are a majority minority state,” Newsom said. “What makes this state great today is that at our best we don’t tolerate that diversity; at our best, we celebrate that diversity.” We have more dreamers in this state, undocumented residents in this state, more immigrants in this state. “What makes California great is we practice pluralism.”

This debate is an indicator that the Democratic party in California has refined the arguments for single-payer health care, investment in mental health, unions, and immigration, and their rhetoric highlights togetherness and interdependence between the political parties. The policies developed in California, with specific regards to healthcare, are sure to frame the policy perspectives of the next Democratic presidential candidate. If the next governor of California is one of the candidates at this debate, they will have the added pressure to prove that these policies can be effectively implemented on a state level if the Democratic party has a chance of implementing them on a national level.

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