The California Assembly Appropriations Committee killed CalCare on May 16, 2024. No floor vote. No debate on the merits. Assembly Appropriations Chair Buffy Wicks, a Democrat from Oakland, held the California Guaranteed Health Care for All Act in committee without ever sending it to the full chamber.[1] California Democrats held 62 of 80 Assembly seats that day. A supermajority. More than enough to pass anything the party wanted before the afternoon session.
They chose not to. That is the point.
This is not a story about Republican obstruction. There are almost no Republicans left in California. This is a story about what the Democratic Party does when it holds every lever of power and still will not act. The pattern plays out in Sacramento, in Albany, in Washington. Across thirty years of campaign promises, committee meetings, and the steady flow of insurance industry money that makes all those promises vanish before they reach a floor vote.
The nurses are furious. You should be too.
| What Happened | Who Killed It | Year |
|---|---|---|
| CalCare (AB 2200) held in committee without a vote | Buffy Wicks (D-Oakland) | 2024 |
| AB 1400 withdrawn before a vote, no Dem votes available | Ash Kalra (D-San José) | 2022 |
| SB 562 shelved after clearing the Senate 23–14 | Speaker Anthony Rendon (D-CA) | 2017 |
| Single-payer removed from the table during Democratic federal trifecta | Obama / Baucus | 2009 |
| Public option killed, doctors arrested for asking to testify | Baucus / Reid / Lieberman | 2009 |
| NY Health Act stalled despite Democratic supermajority trifecta | NY Senate and Assembly leadership | 2019–present |
How Bad Is the Problem
Americans pay more for healthcare than any country on Earth. The United States spends roughly $14,885 per person per year on healthcare, which works out to 17.2 percent of GDP.[2] The average for comparable wealthy nations — Germany, France, Canada, the UK, Japan — runs around $7,860 per capita, or about 11.2 percent of GDP.[2] The U.S. spends roughly double what its peers spend. And what does it get for that premium?
Shorter lives. Higher maternal mortality. More medical debt. More uninsured people dying of conditions their doctor could treat if they could afford the copay.
The life expectancy gap says the rest. American life expectancy stands at 78.4 years. The peer-country average is roughly 82.7 years.[2] The U.S. maternal mortality rate is 18.6 deaths per 100,000 live births. The peer-country average is 5.1.[2] American women die in childbirth at roughly 3.6 times the rate of women in countries that simply decided healthcare is a public good.
A peer-reviewed 2020 study from Yale, published in The Lancet, found that Medicare for All would save approximately $450 billion per year and prevent 68,000 deaths annually.[3] Lead researcher Dr. Alison Galvani called that figure conservative, because it did not account for deaths among the underinsured who skip care over copays and deductibles.
“Our study is actually conservative because it doesn’t factor in the lives saved among underinsured Americans.” — Dr. Alison Galvani, Yale School of Public Health, The Lancet, 2020 [3]
Every peer nation offers universal coverage. Every peer nation spends less. Every peer nation lives longer. The only people who think this is a hard problem are the ones getting paid to think so.
California’s Thirty-Year Murder Spree
California Democrats have killed single-payer legislation at least six times since 1994.[4] Six times. The state has had a Democratic supermajority for over a decade. Each time a bill advanced, a Democrat stepped forward to stop it. Always with a principled-sounding excuse. Always with the same outcome.
Wicks justified the kill by citing California’s budget pressures.[1] This would be more convincing if AB 2200 had an immediate fiscal impact. It did not. The Appropriations Committee’s own analysis confirmed the bill was a policy framework with no immediate cost. The savings come later. The Healthy California for All Commission found single-payer could cut the state’s annual healthcare spending from roughly $517 billion to about $382 billion, a difference of $135 billion per year.[1] The bill was killed to protect a budget while leaving $135 billion per year on the table.
Wicks’s biography is itself the story. She worked in the Obama White House on the ACA. In her 2018 Assembly race, Walmart heirs Carrie Walton Penner and Gregory Penner funneled $944,600 into supporting PACs. She outspent her opponent, DSA-backed single-payer advocate Jovanka Beckles, by four to one.[6]
The California Nurses Association issued a statement the day of the kill. It was written by people who have watched this happen before.
“Legislators say they support single-payer, but do not back up their words with action.” — Cathy Kennedy, RN, President, California Nurses Association, May 16, 2024 [1]
Then there is Gavin Newsom. He ran for governor in 2018 on a single-payer platform. The CNA endorsed him and put his name on a campaign bus. After he won, he did nothing. When AB 1400 was alive in early 2022, Newsom said he had not had “the opportunity to review that plan” and that “no one has presented it to me.”[7] He had been governor for three years.
California Democrats hold a 62–17 supermajority in the Assembly and a 32–8 supermajority in the Senate. They need 54 Assembly votes and 27 Senate votes to pass anything. Single-payer has the numbers. The party does not have the will. And the will went to whoever signed the checks.
New York: The Sequel Nobody Needed
The New York Health Act was first introduced in 1992.[8] It has been reintroduced every legislative session since. Democrats have controlled the New York Senate since 2019, holding a 41–22 majority. The Assembly has been in Democratic hands for decades, currently running roughly 102–48.[8] Governor Hochul is a Democrat.
The bill has not received a floor vote in either chamber since the Democratic trifecta began. Not once.
It has been endorsed by 1199 SEIU, the New York State Nurses Association, Make the Road New York, and Physicians for a National Health Program. Assembly versions cleared the chamber multiple times in earlier years when Democrats did not control the Senate. When they finally won the Senate in 2019, advocates assumed the blockade was over. It was not over.
Senate Majority Leader Andrea Stewart-Cousins and Assembly Speaker Carl Heastie have repeatedly declined to bring the bill to a floor vote with no substantive explanation.[8] As Gothamist reported after the 2019 session closed without action: “When Senate Democrats took control of the chamber in 2019, there were high hopes that the New York Health Act would finally come to the floor for a vote. It never did.”[8]
New York is the financial capital of the American healthcare industry. It is home to some of the largest hospital systems, insurance companies, and pharmaceutical operations on Earth. The idea that the state’s Democratic leadership cannot see a conflict of interest there is, charitably, naive.
Obama Had the Votes. He Had the Speech.
On June 30, 2003, Barack Obama addressed the Illinois AFL-CIO Civil, Human and Women’s Rights Conference. He was a state senator at the time. Here is what he said.[9]
“I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. A single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we’ve got to take back the White House, we’ve got to take back the Senate, and we’ve got to take back the House.” [9]
By January 2009, Democrats had all three. The White House. A 60-seat filibuster-proof Senate. A 257–178 House majority. The exact conditions Obama had said were necessary.
He took single-payer off the table before the first hearing.
At a May 2009 New Mexico town hall, Obama acknowledged that starting from scratch, single-payer “could very well make sense,” and then explained the U.S. was “not starting from scratch.” That was it. No study. No proposal. No vote. A campaign promise dissolved the moment it became inconvenient for the people who financed the campaign.
And who had financed the campaign? The healthcare industry gave Obama $20.18 million in the 2008 cycle. Roughly three times what John McCain received from the same industry.[10] Health professionals, hospital systems, pharmaceutical companies, HMOs, and health insurers collectively decided Obama was the better investment. They were right.
The Bill Was Written by an Insurance VP
Senate Finance Committee Chairman Max Baucus ran the ACA drafting process. He was the right man for the job, from the industry’s perspective. A Center for Responsive Politics analysis found that in the preceding six years, nearly one quarter of every dollar Baucus raised came from health and insurance interests. He had received more healthcare industry money than any other member of Congress at the time.[11]
In May 2009, Baucus convened a Senate hearing on healthcare reform with 41 invited witnesses across three days. Not one of them advocated for single-payer. Karen Ignagni, president of America’s Health Insurance Plans, the industry’s main lobbying arm, was escorted into the room by staff members. When eight doctors, nurses, and activists stood up one by one to ask why single-payer had been excluded from the room, Capitol Police arrested them and charged them with disrupting Congress.[11] A second round of protests added five more arrests. Activists called them the Baucus 13. The committee continued its work without interruption.
The bill was drafted in large part by Liz Fowler. Fowler served as Baucus’s chief health policy counsel from 2009 to 2010. Immediately before that, she was Vice President for Public Policy and External Affairs at WellPoint, then the largest health insurer in the United States.[12] After helping write the law, she moved to the White House to oversee its implementation. After that, a senior policy role at Johnson & Johnson.[12] Baucus called her a “key author” of the legislation from the Senate floor. Investigative journalist Marcy Wheeler traced Fowler as the document’s literal author by examining Word file metadata.
Liz Fowler: WellPoint VP → Baucus chief health counsel (wrote the ACA) → Obama White House (implemented the ACA) → Johnson & Johnson VP → Biden's CMS Innovation Center director.
Tom Daschle: Senate Democratic Majority Leader → paid lobbyist, Blue Cross Blue Shield.
Max Baucus: Finance Chair (steered the ACA) → U.S. Ambassador to China.
The public option, a government-run plan that would have competed with private insurers, was killed by Joe Lieberman. Lieberman was a Connecticut senator whose largest industry donor throughout his career was the insurance sector, concentrated in Hartford.[13] Senate Majority Leader Harry Reid and the White House capitulated without a sustained fight. Insurance company stocks doubled and tripled in the years after the ACA’s passage. The industry spent over $1.1 billion lobbying on the legislation in 2009 alone.[11]
Follow the Money
The argument that Democrats are less captured than Republicans on healthcare requires ignoring a lot of numbers. Here are the numbers.
| Donor / Cycle | Amount to Democrats | Note |
|---|---|---|
| Healthcare industry → Obama, 2008 cycle | $20.18 million | 3× what McCain received [10] |
| Health insurance industry, 2020 federal cycle | ~$120 million total | Record cycle [14] |
| UnitedHealth Group, 2024 cycle | ~$988,000 (59% to Dems) | OpenSecrets [14] |
| Centene Corp. → Democratic Senate candidates, 2018–2024 | $38.88 million | vs. $19.16M to Republicans [14] |
| Pharma PACs → Rep. Scott Peters (D-CA), 2023–24 | $133,000+ | Peters co-sponsored bills to limit Medicare drug negotiation [15] |
| Insurance industry lobby spend on the ACA, 2009 | $86.2M through U.S. Chamber alone | To kill the public option [11] |
Four Democrats — Scott Peters of California, Wiley Nickel of North Carolina, Josh Gottheimer of New Jersey, and Donald Davis of North Carolina — co-sponsored Republican-led bills in 2023 and 2024 designed to limit the scope of Medicare drug-price negotiation under the Inflation Reduction Act. Pharma PACs sent those four roughly $300,000 in the 2023–24 cycle.[15] Peters told constituents he was not going to “unilaterally disarm and defund my campaign so that Republicans can win.” That is a perfectly honest description of how the system works.
The pharmaceutical industry has historically leaned Republican, roughly 64 percent over time. That gap has narrowed dramatically since Democrats took Senate committee chairmanships in 2021. The industry now splits contributions strategically, buying access and deference in both directions. The insurance sector has skewed Democratic in recent major cycles. When Centene, the largest ACA-marketplace insurer in the country, sends twice as much money to Democratic Senate candidates as to Republicans, it is not because it admires their values.
Resistance Theater
Since 2017, the Democratic Party has had one political identity: it is not Trump. That is the entire pitch. No structural reform agenda. No healthcare program. Just: we know what NATO is, we wear masks, and we issue very firm statements while the republic burns.
Here is what “resistance” actually looks like in the voting record.
In December 2025, the House voted on Trump’s FY2026 National Defense Authorization Act. A record-setting $901 billion Pentagon budget. It passed 312–112. Of those 312 yes votes, 115 were Democrats. Minority Leader Hakeem Jeffries voted yes. Minority Whip Katherine Clark voted yes. Caucus Chair Pete Aguilar voted yes.[17] The Senate passed the same bill 77–20.
In April 2024, as the Gaza death toll crossed 30,000, the House voted on a $14.3 billion military aid package for Israel. It passed 366–58. Approximately 173 House Democrats voted in favor.[18] A Sanders Senate amendment to block offensive weapons transfers received zero Democratic cosponsors in the chamber. Cory Booker explained his no vote with corporate boilerplate about “security guarantees.”
The same party that cannot pass single-payer in a California supermajority found 115 members willing to hand Trump a record military budget. The same senators who post about democratic norms voted to arm a military operation that has killed more than 50,000 people. They opposed Trump loudly on Instagram and voted for his Pentagon bill on the floor.
“It should come as no great surprise that a Democratic Party which has abandoned working class people would find that the working class has abandoned them. While the Democratic leadership defends the status quo, the American people are angry and want change. And they’re right.” — Bernie Sanders, November 6, 2024 [19]
Nancy Pelosi responded to that statement by saying she did not “respect” Sanders’s characterization of the party. Neither she nor DNC Chair Jaime Harrison mentioned healthcare, wages, or drug prices in their rebuttals. Neither explained why the party with a California supermajority cannot pass single-payer. Neither offered an alternative agenda.
They defended the status quo. Which is, of course, what the status quo pays them to do.
What $450 Billion a Year Looks Like
The math is not complicated. The United States spends roughly $4.9 trillion per year on healthcare. The Yale/Lancet study found that a properly designed universal system would cut that by roughly $450 billion annually while covering every person in the country.[3] That is money currently flowing to insurance executives, billing administrators, and shareholders, extracted from sick people and working families and redirected to quarterly earnings reports.
Administrative costs are the purest expression of the rot. Medicare runs on roughly 2 to 3 percent overhead. Private insurance runs at 12 to 18 percent, and the ACA’s medical loss ratio caps it at 15 to 20 percent, meaning insurers can legally spend one dollar in six or seven on overhead, profit, and executive compensation rather than patient care.[16] The Center for American Progress estimated that billing and insurance-related administrative costs total approximately $496 billion per year. That is not care. That is paperwork. That is what Americans pay so that insurance companies can exist as intermediaries between sick people and doctors.
The whole system is a protection racket dressed in actuarial language. Every year it continues, it costs approximately 68,000 lives. Every year, the Democratic Party collects its contributions, issues its statements, and kills the bills. The Republicans do it louder, with more obvious contempt for the people dying. The Democrats do it quietly, with better branding, and then ask for your vote because at least they are not Trump.
They are the healthcare industry’s favorite progressives. And the industry gets its money’s worth every time.
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