Universal health care — or single-payer health care, or medicare for all, or socialized medicine — has come of age as a mainstream political issue in the United States. There is now an "official" Medicare for All Caucus in the U.S. House of Representatives that launched with 66 members.

The latest research indicates a majority of Americans support some form of government guarantee of health care. But while Democrats and Republicans at the federal level attempt to coalesce their competing visions into something practical, Democrats in the state of California are leading by example — and hoping for the best.

California now has, at least on paper, a universal health care system. Rather, it has an "intention" of creating one. That probably doesn't sound like a major development yet, but it is — especially in a state as large as this one.

It's true, however, that the details of the plan are a long way off from solidifying into something convincing and workable. There's a lot of potential and momentum for universal health care. But this is essentially a pilot program for the rest of the country — and a lot of eyes are watching how events play out, as well as closely studying the key difference between the phrases "public option" and "single-payer."

Who Brought This to Fruition?

There was a bit of political drama in California amid a recent heated primary season. The Lieutenant Governor at the time, Gavin Newson — who has since won his primary and became the favorite to take the governorship later this year — made universal healthcare a major part of his campaign.

At around the same time Newson was winning his primary and becoming current governor Jerry Brown's most likely replacement, the California State Assembly passed, in a legislative flurry, a 2018-2019 budget for the state that included, in clear language, "the intent of the Legislature to provide coverage and access through a unified financing system for all Californians, to control health care and administrative costs, to ensure high-quality health care, to limit out-of-pocket costs, to train and employ an adequate health care workforce, and to ensure all Californians have timely access to necessary health care."

A useful comparison might be the U.N.'s Universal Declaration of Human Rights, which recognizes healthcare a vital public service and a human right without actually going into specifics about how such a thing might come about or be financed.

The California general assembly is a governing body that can take an immediate and incisive stance on this issue now that it has an official mandate. But what's the plan to move forward from here?

How Will Universal Health Care in California Come Together?

California is, even now, taking concrete steps forward to turn universal health care into a reality for all Californians.

One of the first steps is the formation of the Council on Health Care Delivery Systems. This group will consist of three governor-appointed members and two appointed by the state legislature. Between their appointments and October 2021, their task is to devise and bring forward a complete vision for universal health care in California — including specifics on how it's going to be paid for.

Commissions like this one are seen by some cynics as a way to punt controversial issues for a while in times of significant political uncertainty. But even if that's true, Californians now have binding language from its state government indicating it is actively pursuing a way to cost-effectively provide for the health care needs of every resident of the state.

What's the Cost? Who's on Board? And What Does the Fine Print Say?

What's the expected price tag? Experts believe California will need $100 billion in new taxes and revenue per year to pay for such a system.

There is talk of meeting cost estimates with "federal waivers," but little else is known about Democrats' plans so far, which the California Nurses Association calls "piecemeal." They go on to outline their stance in greater detail, which edges into palpable frustration at times over the pace of the health care conversation in California.

In summary, neither the ACA's "bribery" (their words) of insurance companies nor some California Democrats' plans to provide a "public option" (a government-run alternative to, rather than an overhaul of, health insurance in California) are enough to satisfy the real health care needs of Californians.

Moreover, a public "option," if it didn't commit to true universal coverage, would become a repository of only the sickest and most desperate citizens. This is the opposite of what "social" health care is intended to accomplish, which is to diffuse the risk and the expense across as large a pool of "insured persons" as possible.

For right now, with both U.S. congressional elections as well as the California gubernatorial election heating up, decidedly "blue" California is having a debate about how "blue" to go. The Nurses Association represents many people who operate "on the ground" in the healthcare industry daily and have committed themselves to true single-payer healthcare. Meanwhile, self-styled "pragmatists" within the Democratic Party suggest a slower and more deliberate rollout.

By October 2021, we should see some clarity from California one way or another — unless there's a major federal or state-level breakthrough before the commission has completed its work.