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Rich Pedroncelli / AP

A $400 billion proposal for single-payer health insurance is making its way through California legislature, but some worry that it would be too cost inefficient because it relies on the old fee-for-service system for paying doctors and hospitals.

The plan: Any resident of California would be eligible to receive coverage without copayments, premiums, or deductibles — no matter their employment, immigration status, or age. And under the "Healthy California Act" patients would have the freedom to see any medical provider for any service.

Why it matters: Most health care experts agree that fee-for-service medicine — where doctors and hospitals are paid for every test and procedure — encourages unnecessary medical spending, and the trend has been to try to move away from it.

More money, more problems: The bill isn't cheap. Coming up with $400 billion each year to maintain this bill would be difficult, considering current government funds allocated to health care coverage would only cover approximately $200 billion. The rest would inevitably have to come from taxpayers' checks, which would be a hard sell for politicians to make to their constituents. What they're saying: The bill's authors argue that it wouldn't entirely return to the traditional fee-for-service rules; rather, they hope to use managed care and urge health care professionals to provide preventative services to patients. Ricardo Lara, a California senator and sponsor of the bill, said he has heard the various concerns with it and is now looking outside of the U.S. to see how other countries with single-payer systems control their costs.The other side: The Senate Appropriations Committee released an analysis of the bill (which supporters hope will receive a Senate vote this Friday) that expressed skepticism over some of its more nuanced details — particularly the idea that patients can see any provider they want without a referral. Similarly, the report questioned the bill's ability to control costs via allowing "health care delivery systems can choose to be paid on a capitated basis," per California Healthline.

Go deeper

Scoop: CIA director Gina Haspel almost resigned over plan to install Kash Patel as deputy

Photo: Win McNamee/Getty Images

CIA Director Gina Haspel almost resigned in early December after President Trump cooked up a hasty plan to install loyalist Kash Patel, a former aide to Rep. Devin Nunes (R-Calif.), as her deputy, according to three senior administration officials with direct knowledge of the matter.

Why it matters: The revelations stunned national security officials and almost blew up the leadership of the world's most powerful spy agency. Only a series of coincidences — and last minute interventions from Vice President Mike Pence and White House Counsel Pat Cipollone — stopped it.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Coronavirus deaths reach 4,000 per day as hospitals remain in crisis mode — CDC warns highly transmissible coronavirus variant could become dominant in U.S. in March.
  2. Politics: Biden says, "We will manage the hell out of" vaccine distribution — Biden taps ex-FDA chief to lead Operation Warp Speed amid rollout of COVID plan — Widow of GOP congressman-elect who died of COVID-19 will run to fill his seat.
  3. Vaccine: Battling Black mistrust of the vaccines"Pharmacy deserts" could become vaccine deserts — Instacart to give $25 to shoppers who get vaccine.
  4. Economy: Unemployment filings explode againFed chair: No interest rate hike coming any time soon —  Inflation rose more than expected in December.
  5. World: WHO team arrives in China to investigate pandemic origins.

NRA declares bankruptcy, says it will reincorporate in Texas

Wayne LaPierre of the National Rifle Association (NRA) speaks during CPAC in 2016. Photo: Saul Loeb/AFP via Getty Images

The National Rifle Association said Friday it has filed for Chapter 11 bankruptcy and will seek to reincorporate in Texas, calling New York, where it is currently registered, a "toxic political environment."

The big picture: The move comes just months after New York Attorney General Letitia James filed a lawsuit to dissolve the NRA, alleging the group committed fraud by diverting roughly $64 million in charitable donations over three years to support reckless spending by its executives.