Washington State "Single-Payer" Initiative: Large Bill, Less Accountability

January 3, 2001

A campaign to bring a single-payer health-care system to Washington state residents through the initiative process failed to collect enough signatures to place it on the ballot in 2001. But this type of system has been proposed again and again in the U.S., so it is instructive to look at what it would entail.

Initiative 245 would have created a "single-payer" system in which a new state government entity would pay for basic health care for every state resident. It would have been financed by a new business tax and individual assessments. It would have been governed by an unelected board. Its $10.4 billion budget would not have been subject to the normal appropriations or oversight processes.

  • The proposed business tax ranged from 6 to 12 percent of total payroll, with firms employing more people paying a progressively higher rate.
  • Individuals with incomes above 250 percent of the poverty level -- $41,650 per year for a family of four -- would have paid a monthly "premium" of either $50 or $75 per month for the program.
  • Those with incomes below 150 percent of poverty would have paid nothing; those between 150 and 250 percent would pay only a portion.
  • Less than 44 percent of the state's population would have paid the full premium.

Other impacts of the initiative include:

  • Bringing approximately one-seventh (over 14 percent) of the state's economy under state control.
  • Requiring the state to secure as many as 20 different waivers from the federal government and forcing state residents from federal programs into the state program.
  • Creating a central data bank of medical records of all state residents.
  • Requiring all state and local governments to pay the individual assessments for their workers.

Source: Paul Guppy, "The Single-Payer Health Care Proposal: A Guide to Initiative 245," September 2000, Washington Institute Foundation, 4025 Delridge Way, S.W., Suite 210, Seattle, Wash. 98106, (206) 937-9691.

 

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