Could I buy extra insurance, outside of a single-payer system?

It is unclear whether California, if it adopted a single-payer program, would include the possibility of supplemental or premiums plans. Single-payer systems can be as open or closed as its creators wish.

Under last year’s proposal in the Legislature, private insurers would be barred, and the government would cover all services. The only way to get care outside of the plan would be to pay cash. Supporters of this version say outside plans would defeat the purpose of a single-payer system and could insinuate that the system is deficient.

Some countries with universal health care do allow outside insurance plans, such as those provided by certain employers. Others permit supplemental insurance for premium services, such as cosmetic surgery, not covered by the universal plan. In Canada, private insurance is not allowed for hospital or doctor coverage but is permitted for prescription drugs.

Experts are not sure whether offering supplemental plans would increase public support for single-payer care. Most Americans get their health insurance through their employer, and the single-payer proposals have been too vague for meaningful comparison.