Tom Steyer, the controversial billionaire who ran unsuccessfully for president, is trying to appeal to California voters with a “single-payer” health care policy.

He is not alone. Former Congresswoman Katie Porter and former Health and Human Services Secretary Xavier Becerra also proclaim their support for single-payer. 

Together, these three are California’s highest-polling Democrats running for governor. And with support for “single-payer,” they are united behind what would be one of the biggest expansions of government power ever proposed in this state.

“Single-payer” sounds technical. Clean. Almost harmless.What it means is that the government pays the bills. Which means, ultimately, the taxpayer.

When Steyer, Porter and Becerra say California needs single-payer health care, they mean a government-run financing system that would replace private insurance as the main payer of health care costs. 

In fact, as it’s been introduced in the legislature, it would prohibit private insurance companies from providing any services offered by the newly mandated government health care program. So even if you like what you have now, it will be gone as you know it under this new regime.

And the state of California would become the dominant financial gatekeeper for health care for nearly 40 million people.

That is the ballgame. Under single-payer, existing health care plans in California would be displaced by one giant government plan. Employer coverage, union-negotiated plans, private individual policies, and much of the current insurance market would be pushed aside. 

Think less “consumer choice” and more government control. Start with the cost.The commonly cited estimate, based on prior single-payer analyses, is roughly $392 billion a year. Not over a decade. Just for each year.

California’s entire 2025-26 state budget is about $321 billion, including roughly $228 billion from the General Fund. 

So the gross annual price tag for this new government health care system would exceed the entire current state budget and be about $164 billion more than the General Fund itself.

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That is not reform. That is creating a second state government, devoted almost entirely to health care.

The money has to come from somewhere.

And no, you could not remotely come close to paying for this spending behemoth by taxing billionaires.

That is where the sales pitch collapses.

Steyer can talk about taxing billionaires and corporations. Of course he can. That is the applause line, especially from a billionaire trying to sell himself as a tribune of the people.

But the math does not work. Even confiscatory taxes on billionaires would not come close to covering a recurring annual cost approaching $400 billion.

That is why previous California single-payer financing proposals went much further in proposing taxes. The prior CalCare tax plan included a gross receipts tax on businesses; payroll taxes on employers and employees; and higher personal income taxes.

In other words, businesses pay. Workers pay. Employers pay. Households pay. Consumers pay indirectly when costs get passed along.

This is the oldest trick in Sacramento. Sell a massive government expansion as if someone else will pay for it. Then the program launches, costs explode, and everyone finds out they are “someone else.”

Then comes the bureaucracy.

A California single-payer system would entail a state-run health care financing apparatus with a governing board, a trust fund, rules, waivers, mandates, rate-setting, reimbursement disputes, and political pressure over what is covered, who gets paid, and how much.

Supporters call that “streamlining.”

Californians who have dealt with the DMV, the unemployment department, homelessness programs, high-speed rail, Medi-Cal backlogs, or wildfire bureaucracy may call it something else.

And what happens when costs exceed projections? Sacramento has only a few choices: raise taxes, cut provider payments, restrict access, delay care, narrow coverage, or pretend none of it is happening until the next budget crisis.

Californians do not need a policy seminar to understand the basic problem. When the government becomes the payer, it becomes the center of power. It decides how much money is available, how much providers get paid, what gets covered, what gets delayed, and what gets squeezed.

Our health care system has serious problems. Premiums, deductibles, drug costs and provider networks are squeezing families and employers.

But much of that dysfunction is already the product of decades of government mandates, regulations, subsidies, tax distortions, and political meddling. 

Steyer looks at a system made worse by government intervention and concludes the answer is vastly more government intervention.

That is not reform. That is doubling down on the disease and calling it the cure.

There is a reason California’s Democratic supermajority keeps failing to pass single-payer. They love the slogan, rallies, and union applause. 

Then the numbers show up. The tax hikes appear. The private insurance disruption becomes clear. Federal waiver questions pile up. Suddenly, even Sacramento Democrats discover caution.

Single-payer is popular as a slogan because it obscures the trade-offs. Government-run health care is less popular when voters understand the price tag, taxes, bureaucracy and loss of control.

When they say “single-payer,” here’s what they aren’t telling you:

The payer, ultimately, is you.

Jon Fleischman, a longtime strategist in California politics, writes at SoDoesItMatter.com.