In California Governor Race, Single-Payer Is a Litmus Test. There’s Still No Way To Pay for It.
California Democrats treat single-payer health care as a required faith statement, yet every leading candidate dodges the $731 billion question of how to pay for it.
Leading Democrats vying to replace Gavin Newsom have turned single-payer health care into a mandatory progressive credential, brandishing the slogan in debates and ads while offering voters zero workable funding plan for covering California’s 40 million residents.
Xavier Becerra, once a longtime congressional backer of single-payer, now soft-pedals after winning the endorsement of the California Medical Association, which has fought the idea for years. At a May 5 CNN debate he pivoted to “Medicare for All” at the federal level and stressed protecting Medi-Cal from coming federal cuts instead of committing to a state-run system. He told voters Californians “don’t care what you call it, so long as they have affordable healthcare.”
Tom Steyer, who opposed single-payer during his 2020 presidential run, now calls it central to his platform and promises to pass legislation long backed by the California Nurses Association that stalled under Newsom. When asked how he would cover the estimated $731.4 billion cost, Steyer offered only that “God is going to be in the details.” Katie Porter has flip-flopped too, telling delegates she would “deliver single-payer” after earlier calling it unrealistic in the near term.
The pattern repeats California history. Newsom campaigned as a “healthcare governor” then retreated to incremental Medi-Cal expansions and cost-containment measures. Vermont passed a single-payer law only to abandon it when no funding source appeared. Any California version would also require federal permission to reroute Medicare, Medicaid, and other dollars, permission unlikely under the Trump administration.
Healthcare experts watching the race note that few voters actually expect the next governor to enact single-payer. Larry Levitt of KFF calls it a “litmus test,” more signal than substance. Democratic consultant Danielle Cendejas says what voters really want is immediate relief from premiums, drug prices, and long waits for care. Yet the rhetorical arms race continues because Democrats outnumber Republicans nearly 2-to-1 and the top two finishers advance regardless of party.
Republican candidates dismiss the idea outright. Steve Hilton warned of “taxes sky high” and subpar care modeled on the United Kingdom. Even some Democratic voters like Jennifer Easton in Oakland treat single-payer as a 20- to 25-year horizon at best. The candidates’ shared refusal to grapple with money exposes the gap between what wins applause in a primary and what can actually be governed.
Original reporting: KFF Health News.
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