Will California create the nation’s first single-payer health care system?

High-profile lawmakers in California’s Democratic-controlled Legislature, Lt. Gov. Gavin Newsom, the frontrunner in the 2018 race to succeed Gov. Jerry Brown, and Sen. Kamala Harris have said this year that it’s time for California to create a “Medicare-for-all” health care system, echoing a message Vermont Sen. Bernie Sanders has been pushing for years.

A proposal from a pair of Southern California lawmakers to establish a single-payer model went nowhere this year. Assembly Speaker Anthony Rendon killed the bill from Democratic state Sens. Ricardo Lara of Bell Gardens and Toni Atkins of San Diego.

But the political climate in deep-blue California is changing, with Newsom voicing strong support for single-payer, and state Senate President Pro Tem Kevin de León touting his support for the Lara-Atkins bill as he recently launched his campaign to challenge U.S. Sen. Dianne Feinstein next year.

Still, the cost is steep — $400 billion per year, according to a state analysis. That is equivalent to more than twice the state’s total budget of $180 billion.

Health care lobbyists largely sat out during discussions over single-payer this legislative session, reflecting a widely perceived idea that it would not advance. However, powerful special interests have begun to line up to defeat a future proposal.

Changing the way health care is paid for and delivered presents some big challenges.

California is commonly regarded as the state that has most successfully implemented the Affordable Care Act, dramatically reducing the ranks of the uninsured and expanding Medicaid to more than 4 million residents. Many Democrats, including Feinstein, say the state should direct its efforts toward continuing to strengthen that system.

Medicare is also popular, and the existing health care framework is well established. Upending the existing system presents steep functional, political and financial hurdles.

Still, top Democrats say the state has a chance to lead the nation in creating a single-payer health care system.

For my 2017 California Data Fellowship, I’ll examine the cost, political landscape and current health care system in California to provide a fresh, grounded look at the reality of single-payer in California. Here at The Sacramento Bee, we’ve already begun to examine key data that will help explain how and whether this could work, and we’re assembling a list of sources and experts who can illuminate where this effort is headed in California.

[Photo: Justin Sullivan/Getty Images]