PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

Republicans in Congress, especially in the House, are learning a tough, but old lesson: It is almost impossible to get rid of a government entitlement program once it is in place.

Led by House Speaker Paul Ryan, Republicans have tried to make good on a campaign pledge to get rid of ObamaCare, the still-relatively-new health care entitlement started under former President Barack Obama.

The effort is in the process of coming to grief, underlining the old problem of changing entitlements.

Anecdotes about who is losing coverage dominate the political debate no matter how hard public policy wonks like Ryan try to underline the dispassionate rationale for change.

The near failure of the Republican plan has prompted some observers to contend that the only answer is a single payer system, a government-run, government-financed entitlement that would go even farther than ObamaCare.

In fact, California is moving in that direction.

According to Wall Journal editorial writers, “this proves the truism that the liberal solution to every government failure is always more government.”

Many on the left, the Journal continues, “championed single-payer in lieu of ObamaCare’s regulations and subsidies, but in 2010 the program lacked enough support among Democrats in Congress. But with premiums soaring and insurers fleeing the Affordable Care Act exchanges, progressives are now trying to pivot to achieve their longtime dream.”

The California bill reflects the left’s ideal – or, without using political terms, something we all would like if paying for it wasn’t an issue: Free care for everyone for everything.

Patients would be entitled to an essentially unlimited list of benefits, including acupuncture and chiropractic care, as well as “all medical care determined to be medically appropriate by the member’s health care provider.” Patients could see any specialist without a referral. Co-pays and deductibles and charging premiums would be prohibited.

Thus, there would no restraint on health-care use and costs. Patients could get treated for virtually any malady by any physician at no cost.

But even paradise has a price. In California, the Senate committee considering the single payer bill pegged its cost at $400 billion a year, which is likely a conservative estimate since analysts assume utilization rates close to those for Medicaid in which patients lack access to many specialists. About $200 billion could be re-allocated from other government health-care programs including Medicaid and Medicare, though this would require federal waivers. The rest would require higher taxes.

A $200 billion tax hike in California would be equivalent to a 15 per cent payroll tax, which would come on top of the current 15.3 per cent federal payroll tax. The Senate staff analysis estimates that “between 25 per cent and 50 per cent of the payroll tax revenues would represent a new tax on employees, not likely to be offset by higher wages.”

One danger for taxpayers in the other 49 states is that California liberals will drag ambitious Democrats elsewhere to endorse a single-payer system if they want to compete for the 2020 Democratic presidential nomination.

Plus, for those of us in Oregon, public policy proposals often move north and south along the West Coast, so it will be only a matter of time before Democrats here have a single payer bill under consideration.

Okay, so, if not a single payer system, then what?

Well, if I was in charge of health Care policy, I would have five planks in my reform platform.

1. Require all citizens to have health insurance. [As I’ve written before, think of it this way. All of us who drive cars are required to have automobile insurance. If we don’t, we pay a price. The same policy should exist for health insurance, though it will be difficult for many Republicans to stomach this mandate.]
2. Provide a catastrophic health insurance plan for those who cannot afford regular insurance and who need a lower-cost option. Call it what it is, which a “high-risk pool.”
3. Accommodate people with pre-existing health conditions.
4. Allow broad access to health-savings accounts.
5. Save as much as possible of the joint federal and state Medicaid program as a way to provide government-financed care for low income citizens.

Will these proposals solve all of today’s health care problems? Of course not. But they will go a long toward removing incentives for a single payer system, which, frankly none of us can afford, especially if we to preserve funding for important priorities such as K-12 education, higher education, and public safety.

Just ask Californians as they contemplate huge tax increases to fund government health-care-for-all.