California Watch

For Democrats, perhaps the most frightening result from Tuesday's election in Massachusetts was this: At least 42 percent of voters said they went to the polls to defeat health care reform.

The loss of former Sen. Ted Kennedy's seat to a Republican was widely seen as a warning sign to throttle back. But in California, some Democrats and health care activists want to run the other way: They're pushing once again to install a single-payer health plan for the state.

Mark Leno

“I think there is now ever-greater incentive for state legislatures to address health care reform and that is certainly what we are doing here in California," said state Sen. Mark Leno, D-San Francisco.

Leno is referring to SB 810, which he proposed nearly a year ago after it was vetoed twice by Gov. Arnold Schwarzenegger. It would create a single-payer government agency that would take the place of health plans now managed by medical providers.

California activists believe Schwarzenegger would surely veto any single-payer measure this year. But unlike in Massachusetts, where some labor unions compromised with Republicans, California's single-payer proponents hold out hope that union support will help build momentum – if a sympathetic Democratic governor is elected in 2010. In other words, they have a big agenda for 2010, writes Jane Slaughter:

Michael Lighty of the California Nurses Association explained that winning single payer is a multi-year project: heavy education this year, electing a Democratic governor who won’t veto single payer this fall, passing a new bill, taking the measure to the voters in a referendum. The media campaign alone could cost as much as $20 million.

Across the country, Democrats are trying to assess the political fallout from the Massachusetts race. Sen. Barbara Boxer, who is running for  re-election this year, admitted that her seat is now considered competitive: "I think every state is now in play. Every race is a choice. ... You have to make the case that you're the one on the people's side, and you have to feel it in your heart, and people have to get it."

A new Field Poll shows Boxer leading, but below 50 percent support, in matchups against three Republican contenders.

Anthony Wright, the executive director of Health Access California, said the victory for Republican Scott Brown was a clear defeat for health reform advocates, the Sacramento Bee reported. "Haven't watched any cable news tonight. Given my mood, no good can come from it," Wright tweeted Tuesday night.

And, this week, Sen. Dianne Feinstein, California's other Democrat in the U.S. Senate, offered a stark assessment of health reform: "I think we do go slow on health care. People do not understand it. It is so big it's beyond their comprehension. And if you don't understand it and somebody tells you it does this or it does that, you tend to believe it, even though it isn't true. It's hard to debunk all of the myths out there."

Single-payer activists can be relentless on politicians, a big reason why they've been successful in the Legislature. Now, if he runs for governor, Attorney General Jerry Brown could face increased pressure from Democrats and liberal activists to support a single-payer plan. But Chris Reed with the San Diego Union-Tribune doesn't expect an answer soon from Brown:

I’m pretty sure Jerry's going to try to duck the question for as long as he can, because Jerry knows the truth: Single-payer isn’t remotely as popular with the public as its admirers insist. His Dem base wants him to be gung ho on the topic. But he knows that's not going to endear him to independent voters. We'll see.

For his part, Leno says his legislation doesn't have nearly as much bulk as the national health reform proposals, most of all a controversial public option. Nor does it have the bells and whistles of the national plan that includes a raft of pilot projects that could lead to smart changes, as doctor and journalist Atul Gawande explained in the New Yorker.

And what are the odds of the bill becoming law? That, Leno said, depends on who is elected governor. “Unfortunately, this governor has vetoed it twice," he said. "I’m hopeful we can get it to the governor’s desk again." And if not, advocates will take it to the streets for signatures and put it up for a voter initiative. “One way or another, the voters will get the final say,” Leno said.