litmus test

When Gavin Newsom ran for California governor in 2018, his support for a state-run single-payer healthcare system was considered a risky move and earned him hefty labor endorsements.

Today, leading Democrats in the wide-open race to succeed Newsom have embraced single-payer healthcare as a political necessity, an answer to voters fed up with rising premiums and other spiraling healthcare costs.

But with no clear front-runner, they are sparring among themselves in debates and political ads over who is most committed to a government-run model. No candidate has outlined how California would fund comprehensive health coverage for its 40 million residents, leaving voters unable to discern which candidate has a concrete plan for the nation’s most populous state.

Healthcare and political experts said the concept of single-payer has shifted from progressive pipe dream a decade ago to today’s mainstream talking points in a state where Democrats outnumber Republicans nearly 2 to 1. Democrats have pledged the model as the best way to lower costs in an attempt to woo voters worried about affordability as ballots arrive for the June 2 primary. The top two Republicans, meanwhile, have dismissed government-run healthcare as a “disaster” and “socialism.”

“In many ways, single-payer healthcare has become a progressive litmus test,” said Larry Levitt, a former White House policy advisor and a healthcare expert at KFF, a health information nonprofit that includes KFF Health News.

Few voters fully understand the term single-payer, let alone expect the next governor to achieve it, Levitt said. Rather, he added, the term has become more of a signal to voters about a candidate’s approach to healthcare reform.

Xavier Becerra, the former U.S. Health and Human Services secretary, who for decades backed single-payer healthcare in Congress, has come under criticism from opponents for a nuanced but clear shift away from single-payer. It came after Becerra secured an endorsement from the California Medical Assn., a powerful group representing doctors and a longtime opponent of single-payer healthcare bills in California.

At a May 5 debate put on by CNN, Becerra declared his support for “Medicare for All,” a proposal for a federally run system that’s been stalled for years, but he declined to say whether he’d pursue a California-led effort. He said his immediate focus would be on mitigating the drastic federal cuts expected to hit low-income and disabled enrollees in Medi-Cal, the state’s Medicaid program, which covers more than a third of residents.

Becerra is counting on voters not to distinguish between the often-confused terms single-payer, Medicare for All, and universal coverage, noting during the debate that “Californians don’t care what you call it, so long as they have affordable healthcare.”

“A lot of people aren’t clear what single-payer is, and they need a metaphor to understand it,” said Celinda Lake, a Democratic strategist and one of the lead pollsters for former President Biden’s 2020 campaign.

Billionaire activist Tom Steyer, who’s touted his self-funding as a signal he can’t be bought, has emerged as the race’s most vocal advocate of single-payer after opposing it during a short-lived 2020 presidential bid. As governor, Steyer has said, he would pass legislation backed by the California Nurses Assn. that has failed to come to fruition under Newsom’s tenure. Pressed on how he would cover the estimated $731.4-billion cost, Steyer told KFF Health News that “God is going to be in the details.”

At a forum last year, former U.S. Rep. Katie Porter said she didn’t believe achieving such a system was realistic in the near term, but the Orange County Democrat later told party delegates that she would “deliver single-payer.” Former Los Angeles Mayor Antonio Villaraigosa and San Jose Mayor Matt Mahan, Democrats who are trailing their competitors in the polls, don’t support single-payer. The top two vote-getters — regardless of party — advance to the November general election.

Some of the most seasoned politicians have failed to deliver single-payer. Newsom, who campaigned on the promise of being a “healthcare governor,” dialed back his ambitions upon taking office, choosing instead to pursue “universal access” to health coverage under a series of Medi-Cal expansions and efforts to contain healthcare spending.

The campaign bus for billionaire activist Tom Steyer, who has made single-payer healthcare a central pillar of his run for governor, in downtown Oakland.

(Christine Mai-Duc/KFF Health News)

Vermont, which remains the only state to pass a single-payer healthcare law, reversed course when leaders there couldn’t identify a funding source.

To enact single-payer, California would need permission from the federal government to redirect billions of dollars from Medicaid, Medicare and other funding that currently flows to the system — approval not likely to come from the Trump administration.

More than half of adults nationally say healthcare costs will have a major impact on whom they vote for in November, according an April KFF poll.

Danielle Cendejas, a Los Angeles-based Democratic consultant who works with state legislative candidates, said single-payer healthcare increasingly appears on candidate questionnaires from small-business advocates as well as hyperlocal Democratic clubs, in state legislative races and national union endorsements. What most California voters want to hear, Cendejas said, is how candidates plan to give them more immediate relief from higher premiums, expensive drug costs and long waits to access care.

The high price tag doesn’t faze Jennifer Easton, a 63-year-old Democrat from Oakland, who said other countries with similar models have proved they can lower costs. She said she supports a single-payer health system because it’s clear to her that Americans have reached the limits of working within the existing system. But she isn’t expecting any of the current candidates to succeed in implementing one, and she hasn’t decided whom to support.

“No one can in four years,” she said. Seeing a candidate enthusiastically support the concept gives her a good idea of their philosophy. “It is, if we’re lucky, a 20-year, 25-year plan.”

Rob Stutzman, a Republican political consultant who advised former Gov. Arnold Schwarzenegger, said while Americans may be supportive of single-payer in polls, focus groups suggest that approval drops quickly when voters realize it could mean losing their current doctor or insurance plan.

At the CNN debate, Steve Hilton, the Republican candidate President Trump has endorsed, said Californians would end up with subpar patient care and “taxes sky high to pay for it,” like in his native United Kingdom. Instead, Hilton suggested the state stop providing “free healthcare for illegal immigrants who shouldn’t even be in the country in the first place.”

Mai-Duc writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.

LOUISVILLE, Ky. — No trainer has won the Kentucky Derby more times than Bob Baffert. Among other living trainers, nobody has won the Derby more than Doug O’Neill.

Combined the two Southern Californians have eight Derby victories — Baffert (six) and O’Neill (two) — one more than the total for the other 15 trainers in the field.

And yet, O’Neill’s horse for Saturday’s race, Pavlovian, is a 30-1 long shot on the morning-line odds, and Baffert’s starters are 20-1 (Potente) and 30-1 (Litmus Test). Not the odds you’d expect to see if you were just looking at the trainers.

Both know it’s nothing personal.

“It’s a sign of how, really, the sport is all about the horse,” O’Neill said at his barn. “Whether you’re Bob or me or whoever, you’re only as good as your horse. Bob and I are bringing in some horses that don’t jump off the page number-wise. But I was very impressed with Potente’s work the other day.”

Potente’s trainer also understands the odds, noting this isn’t the first time he’s brought long shots to the Derby.

“I mean, I’d rather be here with a horse like American Pharoah or Justify,” Baffert said, referring to his Triple Crown winners from 2015 and 2018. “But then I’d be like Todd [Pletcher]. He’s getting sick. I said, ‘You’re sick because you’ve got the favorite [Renegade].’ When I had Pharoah and Justify, I got so sick. I was so stressed out.”

Baffert added he was thinking at the time, “It was a layup; I better win this.”

If those horses were layups, Potente is more like a three-pointer from Stephen Curry range, while Litmus Test is along the lines of Jerry West’s 60-foot shot in the 1970 NBA Finals.

Of Baffert’s 35 previous starters, three went off at odds of 55-1 or higher (they finished sixth, 10th and 17th), and three others were priced at 20-1 or higher. Two of those finished ninth (25-1) and 15th (27-1), but War Emblem won the 2002 race at 20-1.

O’Neill’s first victory, in 2012, was unexpected; I’ll Have Another was priced at 15-1. Four years later, Nyquist triumphed as the 2-1 favorite. Both horses were owned by J. Paul Reddam, as is Pavlovian. A win Saturday would make the duo just the fourth owner-trainer team to win the Derby at least three times.

“That’s very cool,” O’Neill said, noting that Pavlovian is in the same stall Nyquist occupied a decade ago. “A lot of great memories here.

“But you know, when you’re talking a 20-horse field, I like the way Paul puts it: When you’re one out of 20, you got a 95% chance of losing, right? So when you get lucky enough to win, and you’re part of that 5%, you pinch yourself to how lucky and how amazing that experience was and hopefully could be again.”

Pavlovian is an unlikely Derby horse, and not just because he’s trying to become only the fifth Cal-bred to win the race. It’s mainly because he raced exclusively against Cal-breds in seven of his first eight races and only won one.

The last of those races, though, was the Cal Cup Derby, and a strong finish encouraged O’Neill to try the Sunland Park Derby. With Edwin Maldonado riding for the first time, the son of Pavel won, and in the Louisiana Derby he led almost the entire race before Emerging Market passed him in the final strides.

“For him to put up a great fight with a top horse like Emerging Market, it was a huge effort,” O’Neill said. “And the nice thing there, too, we had extra timing between that race and the Kentucky Derby. Knock on wood, everything’s kind of coming together as we had hoped and prayed.”

While O’Neill never could have expected to be here with his Cal-bred, Baffert will start two of the myriad expensive colts his clients buy each year. Potente, the San Felipe winner and Santa Anita Derby runner-up, cost $2.4 million, more than double any other horse in the Derby. Litmus Test, the Los Alamitos Futurity winner who has disappointed in two starts this year, was purchased for $875,000.

“They’re going to have to improve a lot,” Baffert said. “Potente, we’re still trying to figure him out a little bit, what he wants to do, how he wants to run, but he’s a big strong horse. … He’ll get the mile and a quarter.

“And [Litmus Test] was running really well, and then he sort of took a step back on me, but I did ship him a lot, so that might have knocked him out a little bit. But now he looks good. He worked well here, so we’ll see what happens.”

Second scratch

Fulleffort was scratched Thursday because of a chipped bone in his left hind ankle. Trainer Brad Cox still has his two most accomplished horses running Saturday in Florida Derby winner Commandment and Blue Grass champion Further Ado.

The scratch puts the maiden Ocelli in the field in the No. 20 post position. Great White, who moved into the field Wednesday with the scratch of Silent Tactic, will now break from the No. 19 post.

Kentucky Oaks Day

The filly equivalent of the Derby, the Kentucky Oaks, will be run under the lights at 5:40 p.m. PDT Friday. Zany (4-1) is the morning-line favorite for trainer Todd Pletcher, but two Southern California horses should be strong contenders: Michael McCarthy’s Meaning (5-1), the Santa Anita Oaks winner, and Baffert’s Explora (6-1). McCarthy also will start Brooklyn Blonde (30-1).