California's four Democratic candidates for governor all promised to expand health care for Californians, but are split over whether that approach should be a single-payer system.
At a forum in Anaheim sponsored by the National Union of Healthcare Workers, Lt. Gov. Gavin Newsom reiterated his support for single-payer in California, while former Los Angeles Mayor Antonio Villaraigosa urged caution over adopting a dramatic overhaul that could cost billions of dollars.
"I support in concept the notion of single payer," Villaraigosa said. "When you’re governor, you gotta make the tough choices. You can’t just say I want pie in the sky."
The split over whether to pioneer a statewide single-payer health care system will likely become a signature issue in a race between candidates who largely share similar liberal values.
Villaraigosa's call for fiscal stewardship was met with Newsom's retort that California needs to be at the national forefront of progressive health care policy.
“It's about leadership," Newsom said. "A single-payer system provides the ability to provide more efficiency and more cost controls."
An analysis of Senate Bill 562, the single-payer bill currently on hold in the California Legislature, showed that $200 billion in new revenue would need to be raised for a universal health care system.
Only one candidate at Sunday's forum, former state Superintendent of Public Instruction Delaine Eastin, endorsed SB 562 outright. She said the billions needed could come from a gross receipts tax and a partial income tax increase.
"I’m not sure exactly, but it’s doable," Eastin said, "and we could do it if we put our minds to it.”
State Treasurer John Chiang said the state should take an incremental approach toward increasing health care coverage.
"We don’t have to go all in to provide all the services all at once," he said. "Let’s make sure what we’re implementing, we can scale up appropriately, and show its effectiveness in the program.”
California's top-two primary system magnifies intraparty debates like the one over single payer. The disagreements could dominate the race leading up to the June primary and, if two Democrats advance, continue until the November general election.
Despite Newsom's consistent advantage in early polls, the three other Democrats laid off on attacks against the former mayor of San Francisco.
The forum took place a stone's throw from the state Republican convention in Anaheim. NUHW organizers said the Republican candidates for governor, businessman John Cox and state Assemblyman Travis Allen, declined invitations to appear on the forum.