With all eyes focused on the national healthcare reform debate, California is already tackling many of the same thorny issues raised by policymakers. Healthy San Francisco, the city/county’s 2-year-old universal care measure, would be an ideal example of the Public Option That Could, if not for the fact this is a non-insurance program. Nevertheless, the City by the Bay took matters under its own hands, something not every community may be able to replicate. And, as reformers turn an eye to phasing out fee-for-service payments in Medicare, a significant number of physician groups are moving toward it in San Diego—ironic, given that reformers tend to favor California’s historic managed-care payment model. Amid all this political uncertainty, one company has boldly started the full first-blown health plan in recent memory in the Golden State. Meanwhile, a new breed of Medicare brokers is taking advantage of employer shifts in the way retiree health benefits are funded, which stands to invigorate the individual Medicare market.