The blue wave brings a growing chorus for Medicare for All. Here are the challenges
Your morning catch-up: The challenges of Medicare for All, Nithya Raman defeats Karen Bass and more big stories.
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As newly elected Democrats prepare to ride their historic blue wave into Washington, D.C., high on the wish list for many — including at least one newly elected California congressman — is to provide Medicare for All.
It’s an appealing idea for anyone who has watched their private health insurance premiums skyrocket in recent years, or worried about going bankrupt if they get diagnosed with cancer.
Congressman-elect Randy Villegas, a Central Valley Democrat, campaigned on being a “strong supporter of Medicare for All.” He’s not alone.
But expanding publicly funded health coverage to more Americans — let alone all Americans — would be eye-wateringly expensive.
In fiscal year 2025, the federal government spent about $1.5 trillion (with a T!) on Medicare and Medicaid — the programs for the elderly and the poor. That accounted for nearly a quarter of the federal budget.
A problem beyond the high costs
And then there is another momentous challenge: There simply aren’t enough doctors and nurses to treat everybody.
Governments across Western Europe, Canada and, yes, California have learned that lesson the hard way: Coverage is absolutely not the same as care.
In 2020, my colleague Brittny Mejia and I published an investigation into the Los Angeles County Department of Health Services, which serves more than 2 million people, primarily the region’s poorest and most vulnerable residents.
We found that the average wait to see a specialist was nearly three months. We uncovered case after case in which people died of the very conditions they were waiting to have treated. These were long, agonizing deaths marked by intolerable pain and hopelessness.
Were the doctors, nurses and hospital administrators who got used to this situation — who learned to accept that it’s just something that happens — evil? Of course not; they simply were spread too thin.
For years, well-meaning politicians in Sacramento had been adding more and more people to the rolls of MediCal, California’s government-funded insurance program. From 2000 to 2020, enrollment nearly tripled, from about 5 million to 14 million.
Not enough doctors and nurses to serve the growing pool
The motives behind that expansion were noble. But they were making the core problem worse because they weren’t adding doctors and nurses at anything like the pace needed to keep up.
There is a worrisome, and growing, doctor shortage in the United States. California — especially rural California — is enduring one of the most severe medical shortages in the country. According to a recent survey by the California Health Care Foundation, more than 11 million state residents struggle to get an appointment with a primary care doctor, let alone a specialist.
One problem is a cap on the number of Medicare-funded slots in residency programs — the three to seven years of training medical school graduates complete before practicing independently.
A fix could be years away
For years, powerful physicians’ lobbying groups opposed expanding the number of residencies for fear of “diluting” the profession and, as a result, cutting into their generous pay. But these days, even the American Medical Assn. has acknowledged the bottleneck and urged Congress to fund more slots.
A proposed bill to do just that died a quiet death last year — the Trump administration, with its DOGE-inspired budget cutting, was in no mood to spend more on Medicare.
Maybe that will change with the new Congress, but don’t expect an immediate improvement. You can’t just write a big check and, voilà, lots of new doctors appear. It’ll take years of investment and training to cure this problem.
Top stories
Raman defeats Bass for L.A. mayor
- Nithya Raman will be the next mayor of Los Angeles, making her the first challenger to defeat an incumbent L.A. mayor in more than two decades.
- “Los Angeles, I’m deeply honored to be your next mayor,” Raman, 45, said in a video statement. “I also wanted to pay tribute to Mayor Karen Bass, someone who has given decades of her life to making this city what it is today.”
- Here’s how Mayor-elect Raman will remake L.A. City Hall.
Newsom to commute death sentences of state prisoners
- The governor is seeking to commute the sentences of all 548 prisoners who face capital punishment, reducing them to life in prison without parole.
- The move comes in Newsom’s final months as governor and as he considers a run for president.
How Latino voters helped secure blue victories
- Latino voters who swung toward President Trump in 2024 helped Democrats reclaim the majority in Congress.
- The shift is seen as a rebuke of the president and his party by a group of Americans who have watched as their families and neighbors were detained by immigration agents while their cost of living shot up.
More news
- An L.A. businesswoman fabricated workers and salaries in COVID fraud, netting millions, prosecutors say.
- Prominent L.A. gang interventionist Skipp Townsend was arrested for alleged murder conspiracy.
- Wins and losses: Sports figures turned politicians have mixed results in midterm elections.
- An assault charge against a U.S. citizen ICE allegedly shot from behind was dropped; lawyers say this isn’t over.
- Russell Brand was found guilty of rape and sexual assault in the United Kingdom.
Commentary and opinion
- She’s got political savvy, good timing, or both, columnist Steve Lopez writes. And she’s about to become Mayor Raman.
- Newsom wants to empty death row. Most politicians wouldn’t bother — or dare, columnist Anita Chabria writes.
- Columnist Jackie Calmes on why your parents’ Republican Party isn’t coming back.
- “Beyond the political implications, El-Sayed speaks for those of us who have been othered by our ‘foreign’ heritage, the color of our skin, the food we eat, our accents or the way we pray,” news and culture critic Lorraine Ali writes.
Editor’s pick
Democratic upsets in this year’s midterms could reshape the electoral map, and the fight for the White House in 2028.
More picks
- “You have to be delusional:” L.A. film students are prepared for a shrinking Hollywood.
Things to do
- 🎎Visit Little Tokyo, one of the most walkable, vibrant neighborhoods in Los Angeles where tradition, activism, art, food and Shohei Ohtani paraphernalia collide.
- 🥧Here are 33 L.A. restaurants to order Thanksgiving takeout from.
- 🎸A rock musical based in downtown L.A. makes its long-awaited Southern California premiere at Pasadena Playhouse, two decades after debuting in Northern California.
- 🌕Fireballs and a supermoon: SoCal stargazers should brace for a busy month of astronomical events.
Today’s recipe
This recipe was inspired by the blueberry breakfast bread at Sonoma County’s Sea Ranch Lodge. It makes two wonderfully light, blueberry-laden loaves.
Question for you
Are you feeling hopeful or anxious now that the elections are over?
Email us at essentialcalifornia@latimes.com, and your response might appear in the newsletter this week.
Photo of the day
Games
Here’s today’s mini crossword, plus our other free, daily crossword puzzle, sudoku, word search and jigsaw games.
Have a great day, from the Essential California team
Jack Dolan, investigative reporter
Hugo Martín, assistant editor, Fast Break desk
Kevinisha Walker, multiplatform editor
Andrew Campa, weekend writer
Karim Doumar, head of newsletters
How can we make this newsletter more useful? Send comments to essentialcalifornia@latimes.com. Check our top stories, topics and the latest articles on latimes.com.
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