Dreaming of a state-run single-payer healthcare system? Wake up and enter the real world. Want universal healthcare for all Americans? Medicare for all is the solution.

Not this year or next, but possibly in the future — when Democrats recapture the presidency and Congress.

That’s the clear-eyed, pragmatic fight to engage in, and one advocated by U.S. Rep. John Garamendi (D-Walnut Grove), a longtime healthcare warrior.

“Medicare is far, far more efficient than private insurance companies,” he said. “Using the tax system to collect money for healthcare delivery is extremely efficient. No profits. No commissions. No advertising.”


Garamendi, 72, earned his healthcare credentials decades ago. He has been fighting for universal coverage since Jerry Brown was governor the first time.

The congressman, whose mostly rural district covers the Sacramento-San Joaquin Delta and spreads into eight counties, was first elected to the state Assembly in 1974. Later, he moved to the state Senate, where he headed the Health and Welfare Committee.

Garamendi became California’s first elected state insurance commissioner and won legislative passage of a bill to create a commission that would have devised a universal healthcare system. But Gov. Pete Wilson vetoed the measure. Garamendi’s reform plan, however, became the model for President Clinton’s ill-fated healthcare proposal in 1993.

In 1994, Garamendi ran for the Democratic gubernatorial nomination, advocating a top-to-bottom healthcare overhaul. He lost to then-state Treasurer Kathleen Brown, Jerry’s sister.


After a stint as Clinton’s deputy Interior secretary, Garamendi again was elected insurance commissioner, later became lieutenant governor and left for Congress in 2009.

So Garamendi has paid his healthcare and political dues. A dawn-to-midnight workaholic who grew up on a cattle ranch in the Sierra gold country, he has won and lost but always spoken his mind.

And he believes California has virtually no chance of going it alone on a single-payer system with the state handling everyone’s healthcare coverage.

“It would be very difficult, particularly given the present federal government,” he told me.


That’s an understatement. It would require permission by the Republican-controlled Congress and President Trump for California to use federal Medicare and Medi-Cal money to finance its own healthcare system. That’s not possible.

Plus, let’s face it, there are about 6 million California seniors on Medicare. They’re frequent voters. Think they’re going to trust Sacramento to take over their Medicare coverage? Think again.

Dr. Steve Tarzynski, president of the California Physicians Alliance, agrees.


“The reality is that at the moment, a single-payer bill cannot pass” the Legislature, he wrote in a recent Times opinion piece. “Fighting for one in the immediate term is a waste of time.”

Maybe in the future, he continued. But for now “millions of California voters with relatively good insurance coverage and those on Medicare are fearful of a radical change in their protections.”

The state Senate blindly passed an exorbitantly expensive — $400 billion a year — single-payer bill June 1. Assembly Speaker Anthony Rendon (D-Paramount) wisely quashed it, calling the measure “woefully incomplete.” Now bellicose single-payer bullies are threatening to recall him.

Brown already had dismissed the measure.


“Where do you get the extra money?” the governor asked. “I don’t even get it.”

Former Los Angeles Mayor Antonio Villaraigosa, who is running for governor, called the bill “snake oil.”

Single-payer pushers in Sacramento — the California Nurses Assn. — tried to sell their skimpy proposal as Medicare for all. But in reality it was just the opposite. It would have wiped out Medicare in California, grabbed the federal money and forced seniors into the new state program.

Updates from Sacramento »


Garamendi wrote an op-ed piece for the Sacramento Bee advocating an eventual Medicare-for-all program nationally. It would be “by far the simplest solution” to achieving universal coverage, he said.

“Medicare is one of our most trusted and popular government programs,” he asserted. “For more than 50 years, Americans have trusted Medicare to provide care to the elderly and disabled, funded by the payroll taxes of American workers…. Medicare spending rises at a much slower rate than private insurance…. It could be modified and expanded to cover more people….

“It is an idea whose time is coming.”

It’s coming, but it’s not here yet — not with Trump and the GOP controlling Washington.


Unlike single-payer, Medicare for all would allow beneficiaries to buy supplemental private insurance, as many seniors do now.

Garamendi told me he wouldn’t attempt to increase current benefits. Nor would he try to cover immigrants here illegally. Those would be poison pills politically.

For people fearful of government-run healthcare — the old “socialized medicine” bugaboo — Garamendi notes that much of America already is covered by government insurance.

There are more than 46 million seniors and 9 million disabled on Medicare. About 75 million are enrolled in Medicaid for the poor, called Medi-Cal in California. Roughly 22 million federal, state and local government employees benefit from government-funded healthcare. So do 1.3 million military personnel. That totals almost half the population.


In California, the main focus should be on pressuring Congress to retain and patch up the Affordable Care Act, which has reduced the number of uninsured in this state from roughly 7 million to less than 3 million. The GOP’s repeal threat has been beaten back, but it isn’t dead.

The governor and Legislature can keep making incremental healthcare improvements in California by continuing to restore Medi-Cal benefits that were severely cut during the recession.

But forget about single-payer. Awaken from the midsummer night’s dream, truly a nightmare.

george.skelton@latimes.com


Follow @LATimesSkelton on Twitter

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