"...curious dichotomies that were found mostly only out West.
Hiram Johnson was a nakedly partisan Liberal, a convert to populist Sinophobia not just out of convenience but in time sincere racial conviction, and in Congress a staunch isolationist who clashed with the increasingly internationalist point of view of his party's "Eastern Establishment" concentrated in New England and New York. As Governor of California, however, he had been a trailblazing progressive, working with the Democratic majorities as well as Socialist and left-Liberal legislators to pass a raft of reforms including the most expansive open records "sunshine" laws in the country (and, at the time, the world), devolving the rights of both initiative and referendum to the public, [1] transforming California's state bureaucracy to be a much leaner, professional machine, and had tightened Prohibition laws and prosecuted public corruption while greatly curbing the powers of the Central Pacific Railroad, at the time almost a fourth branch of California's government, through forming a railroad commission before the railroads were nationalized by the Hughes administration in the winter of 1914. He had pursued a clean government underpinned by direct democracy and the war had greatly burgeoned California's industrial economy, with nitrate production in Oakland, shipbuilding in the San Francisco Bay and Long Beach, and oil production in Los Angeles becoming key staples of the war effort, with tens of thousands flocking to the Golden State for this new economy. [2]
Johnson's election to the Senate in 1916, to take office in March of 1917, and would be replaced by William Stephens, a former Congressman and moderate progressive who while a reformer was certainly to Johnson's right. While Stephens would pursue a number of important reforms, most prominently in the advocacy for returning veterans from the war and establishing a bureau and unemployment fund for veterans in California, left-wing leaders in California suspected that he would not prove as able or willing an ally as Johnson. As such, for a group of progressive Democrats and Socialists who had formed a fine working relationship with Johnson on a case-by-case basis decided to proceed with a project they had been completing as 1916 turned to 1917, sending to his desk a constitutional amendment to write into the California constitution "a right to medical care." Johnson, a known supporter of such a provision, signed the bill - it was his second-to-last official act as Governor, as he moved the paper to the side to sign his resignation letter a moment later. The healthcare debate had arrived in American politics.
Medical insurance, as it is today, was a complicated issue in the 1910s, made more complex by the needs of an industrial society and the dangers of both war and modern work. As such, there had been a shortage of doctors and nurses in California, and hospitals and clinics had become exponentially more expensive over the prior several years, and suddenly the idea of healthcare as a social right moved to the forefront. These were not new ideas - in European, early welfarism had explored with similar prospects, and unemployment or accident and injury insurance could be considered a version of such thinking - but even William Randolph Hearst had never proposed going as far as what California was now placing on the ballot. This was a radical step in the direction of socialized medicine.
It was also one which, perhaps, came a bit before its time was ready, and which triggered a predictable backlash from the state's powerful insurance lobby. As it had passed the legislature by simple majority in consecutive sittings, it required a public vote of approval under the laws Johnson had seen passed, and it would go to referendum in June of 1917. Johnson was the most public champion of the amendment, however; Stephens was ambivalent, as was Senator James Phelan, both of whom worried that Chinese immigrants would be given free medical care if the amendment would be passed at taxpayer expense. More conservative Liberals swung behind the opposition, most prominently San Francisco's powerful and influential Julius Kahn, otherwise a close ally of Johnson. As such, the campaign against quickly overwhelmed the proponents, especially with Johnson in Philadelphia for the first sessions of the 65th Congress and thus unable to return to California to campaign on its behalf. A vicious fear campaign demagoguing the amendment saw it defeated, 57-43, [3] and Stephens would never try to pass a reform nearly so ambitious before his defeat in 1918 by Democrat Theodore Bell.
Pandora's Box had been opened, however. Democrats in other states now could look to smaller reforms that would bring them closer to the goal of healthcare as a right, and social reformers such as Richard Ely, who had the ear of progressive Liberals, spoke in favor of such movements. The California amendment had been handicapped by vague language - what exactly did it mean for healthcare to be a right, anyways? - that future reformers could avoid, and the economic malaise of the postwar depression years and critical needs of shell-shocked, wounded veterans would continue building the push towards additional measures to bring quality care to all Americans over the next several decades. The unlikely coalition in California may have failed, but the movement had begun..."
- Second Wave: The Postwar Progressive Revolution of 1917-31
[1] By fiat, I elected not to include recall here, because I think the ease of recall elections in California are, well... silly.
[2] Including obviously from overseas
[3] So this is more or less true to OTL - Johnson did sign this amendment on his last day before heading to DC to be sworn in as Senator. In OTL, though, this was beaten 70-30. Upon discovering this in my research on Johnson I decided it warranted a mention as a subtle kickoff to the "Second Wave" progressivism that will really start cranking into gear in the early 1920s.