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For many Californians, the proposal of a state-run single-payer health system remains a 鈥榩ie-in-the-sky鈥� idea, and odds are it could remain that way, especially if leading advocates can鈥檛 agree on how to get there.

Democratic leaders and advocates who are looking to transform the current complex health care system are divided on their approach. On one side, a coalition of health, labor and civil rights advocacy groups is standing behind , which seeks an incremental path toward 鈥渦nified financing,鈥� where a statewide system would pay for health care for all residents. This could be single payer or a similar model. The bill would task a workgroup of experts and consumers to come up with next steps in advancing toward this goal and deliver a report to the Legislature by next June.

SB 770 also calls for the Newsom administration to engage the federal government, which would need to approve such a system in California, on this issue. The bill, authored by San Francisco鈥檚 Sen. Scott Wiener, is currently making its way through the Legislature 鈥� last week it received the green light from the Assembly Health Committee and is headed to a fiscal committee next.

On the other side, the California nurses union, a longtime driving force behind the single-payer movement, opposes Wiener鈥檚 bill, arguing it could derail its own legislation, . That two-year bill authored by Assemblyman Ash Kalra, a San Jose Democrat, would establish a single-payer system dubbed CalCare. The bill was introduced earlier this year, but won鈥檛 come up for a hearing until the next legislative session. There are currently no details in the CalCare bill, but union leaders said they are using their previous attempt at single payer, Assembly Bill 1400, as a starting point. after its author, Kalra, opted not to take it up on the Assembly floor because he was short on votes.

Last week, Kalra joined the nurses union in publicly opposing Wiener鈥檚 bill, calling it a 鈥渄etraction鈥� from his and the nurses鈥� ongoing efforts.

Single payer has been politically dicey even in blue California because of pushback from the health industry, including health insurers and some physician groups, but also powerful business interests, such as the Chamber of Commerce, citing the tax hikes that would be needed to fund such a system. Still, the status quo costs too much and leaves too many people behind, experts and health advocates say.

Carmen Comsti, lead regulatory policy specialist with the California Nurses Association, said the two bills are conflicting because legislators can use Wiener鈥檚 bill as an excuse to vote down the bill backed by the nurses union next year.

鈥淲e do not believe the Legislature would pick up and pass single payer if they just authorized another work group to consider the program,鈥� Comsti told CalMatters. Instead, it opens the door for legislators to say: 鈥淚t鈥檚 too soon to talk about CalCare and single payer because we鈥檙e studying it,鈥� she said.

But Wiener and those supporting his proposal see the two bills as complementary, not conflicting. For example, to carry out a single-payer system, California would need to eventually seek a waiver, or permission from the federal government, to skirt current rules that dictate how the state can spend federal health dollars. Wiener鈥檚 bill would start those conversations, the author said.

鈥淚f CalCare passes, then at that point California will go to the federal government and make waiver applications. The work here, having those discussions with the federal government will be helpful; it dovetails,鈥� Wiener said during last week鈥檚 hearing.

Some Democrats who sit on the Assembly Health Committee noted they see Wiener鈥檚 bill as a way to get the ball rolling on single payer while they wait for wider support from their colleagues.

Kevin McCarty, a Sacramento Democrat, noted the nurses鈥� single-payer bill last year was 鈥渄ramatically short鈥� on votes. 鈥淚t鈥檚 nowhere close,鈥� McCarty said. 鈥淚n the meantime, are we going to be purists or try to get more? That鈥檚 what I think (SB 770) is trying to do. I don鈥檛 think they鈥檙e mutually exclusive.鈥�

Michael Lighty, president of the , said the point is to follow up on the findings from the Healthy California for All Commission, a group assembled by Gov. Gavin Newsom. The group鈥檚 work culminated last year in , but no action.

Lighty is a veteran in the single-payer movement and at one point worked as the director of public policy for the nurses union. The California Nurses Association is actually part of the health coalition he leads, but on this particular piece of legislation, they haven鈥檛 seen eye to eye.

Another main concern for the nurses union is the language used in the commission鈥檚 report and Wiener鈥檚 bill. 鈥淯nified financing does not equal single payer,鈥� Comsti said. She argued that if 鈥渦nified financing鈥� includes programs that leave room for health insurers or any middlemen to profit, then that essentially goes against the single-payer system they鈥檙e seeking.

Lighty sees the language argument as an issue of nomenclature; ultimately both sides want the same outcome, he said. And after multiple failed attempts to get to single payer, perhaps it鈥檚 time for a new way in, he said.

鈥淭o get the Legislature to adopt a full blown single-payer program in one fell swoop has not proven to be viable politically,鈥� Lighty told CalMatters.

By 2031 health care spending in California is projected to increase by $158 billion; a 鈥渦nified finance鈥� system can help slow down that growth, according to the . Most importantly, extending coverage to all Californians could save about 4,000 lives a year, the report said.

鈥淔olks on both sides of this bill have historically worked very closely together on expanding health care access,鈥� Wiener said. 鈥淭here is this disagreement now and I hope in the future that rift heals, but we all want the same result. We want everyone to have true universal access to health care.鈥�

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit  to learn more.