Besides the foundering State budget, one of the biggest debates “raging” in Sacramento surrounds a handful of proposals for Universal Healthcare.
But first, let’s be clear – these proposals have little to do with improving healthcare – they are about who is going to pick up the tab (no pun intended) – and who can get a few headlines.
The Governor wants businesses, hospitals and physicians to pay; the Democrats want government to foot the bill. Both plans will result in taxpayers shouldering most of the burden.
Both are trying to sell the proposals as providing kids and families the healthcare. Both are wrong — and they probably know it.
None of the proposals will improve the quality of healthcare. None of them will contain escalating costs. None of them will reduce long waits at overcrowded doctor’s offices or the shortage of trauma centers, specialty doctors (especially OB-GYN) or healthcare workers.
Everyone should be concerned with the outcome of this debate, because implementing either the Schwarzenegger or Democrat plans will result in healthcare being rationed by same people who run the DMV, long delays for care, and big tax increases.
They will also create a healthcare "immigration wave”, of people from other areas (especially those with the most chronic problems) immigrating to California so someone else (California taxpayers) will pick up their healthcare bills.
Certainly, there are problems with our current system, however California (and the US) have the most advanced medical care in the world. Medical advances and pioneering work in everything from pediatrics to pharmacology have taken medical care to a whole new level (having lived through medical miracles with my twins, I have a first-hand appreciation for these advances.)
California has about 36 million people. Most experts estimate there are about 6 million uninsured. Of those, almost 1 million can afford insurance, but choose not to get it; another 1 million are eligible for existing government programs, but failed to enroll; nearly 2 million are here illegally. That leaves about 2 million people who are genuinely “falling between the cracks”.
It just doesn’t make sense to screw up the system for 30 million people while trying to find a solution (and failing) for the 2 million people who need help.
If Arnold, Sheila and Fabian (Schwarzenegger, Kuehl and Nunes) would look just a little outside the box (what ever happened to blowing the boxes up?) and move past getting quick headlines or advancing special interest needs, we could at least have a debate about genuine reform. Issues like better cost-containment, purchasing pools, or expanded scope of practice could all be examined.
Or they could take the approach Senator George Runner proposed: he introduced legislation that would create a little better access healthcare without creating a bureaucracy that doles out Healthcare like Welfare. His measure would have expanded clinics, given tax incentives for Health Care Savings and encouraged private-sector solutions.
Reforms are needed to contain healthcare costs, expand coverage and improve emphasis on preventative care. The problem is real – health-related costs are the #1 one cause of bankruptcy in California, too many insurers are cherry-picking healthy people while denying coverage to those most at risk, and we need to do a better job to make healthcare accessible to the 2 million who are genuinely left behind.
But the proposals pushed by the Governor and Democrats won’t make healthcare better or more affordable – it’ll just make our healthcare system as effective as the DMV and welfare.
Strangely, while these proposals are more about insurance reforms rather than healthcare reform, our GOP insurance commission has yet to weigh in on the debate.
Even stranger, while the Governor continues to push his proposal, no one in the legislature will carry the bill…and John Fund from the Wall Street Journal noted the irony that while Schwarzenegger toppled Grey Davis for hidden tax increases and irresponsible government, Arnold’s proposal is a big tax increase and creates a gigantic new government program to administer healthcare like welfare.
THE PLANS:
Governor Schwarzenegger’s Plan
Creates an individual mandate, employers must "pay or play," expands eligibility for public programs, and subsidizes coverage for low-income Californians. (Not a bill.)
AB 8 (Núñez)
Employers must "pay or play," and workers whose firms pay a fee instead of covering health expenses must enroll in a new purchasing program. Expands eligibility for public programs and reforms the private insurance market. (In Senate Appropriations Committee, 7/17/07.)
SB 48 (Perata)
Employers must “pay or play,” and workers earning over 400% FPL must have coverage and pay premiums (up to 5% of income). Expands eligibility for public programs and reforms the private insurance market. (No longer a health reform bill.)
SB 236 (Runner)
Encourages expanded use of clinics, gives tax incentives for Health Savings Accounts, and increases competition among health plans. (No longer an active bill.)
SB 840 (Kuehl)
Creates a single-payer system to cover all Californians, a state-administered system replaces private insurers, and all Californians and employers pay into the system. (In Assembly Appropriations Committee, 7/9/07.)
Gov. Schwarzenegger’s health reform proposal aims to provide affordable health coverage to all Californians, according to his office.
The proposal imposes a mandate that all Californians maintain health coverage. Employers with 10 or more employees are required to offer coverage or contribute 4 percent of payroll toward the cost of employee’s coverage through a purchasing pool. A purchasing pool would be established to administer premium subsidies and offer coverage.
The proposal would be financed through increased federal funding, a 2 percent fee on physician revenue, a 4 percent fee on hospital revenue and sliding scale of individual and family contributions of between 3 and 6 percent of income. The proposal includes specific elements to help control health care costs.
Gov. Schwarzenegger unveiled this plan on Jan. 8 and is currently working with legislative leaders to advance major components of the proposal. The governor’s proposal, however, has not yet been introduced as legislation.
Assembly Speaker Fabian Nunez’s health reform proposal, AB 8, was designed to expand affordable health coverage for Californians. The bill establishes a “pay or play” system and requires employees of firms that “pay” to enroll in the newly created California Cooperative Health Insurance Purchasing Program to receive coverage.
The proposal also expands eligibility for public health insurance programs for children and parents. The proposal aims to improve access to coverage on the individual insurance market by standardizing medical underwriting, clarifying eligibility for the high-risk pool and facilitating comparison shopping.
The proposal would be financed through employer and employee contributions and new federal matching dollars associated with public program expansion.
Speaker Nunez introduced AB 8 on Dec. 4, 2006. The full assembly passed the bill on June 7. The Senate Health Committee passed the bill on July 11 and referred it to the Appropriations Committee where it stands today.
Sen. Sheila Kuehl’s health reform proposal, SB 840, aims to provide health coverage for all Californians by creating a new single-payer system. This new government-administered system would replace private health insurers and would provide a uniform set of benefits for all Californians. A new California Health Insurance System Commissioner would negotiate and set rates for health care services, prescription drugs and medical supplies.
Companion legislation, SB 1014, would finance the proposal via new payroll taxes anticipated at 3 to 4 percent for individuals and 8 percent for employers, an additional income tax on those earning more than $200,000 and anticipated administrative and other savings.
Sen. Kuehl introduced SB 840 on Feb. 23 and the full senate passed the bill on June 6. Then on July 3 the bill passed the Assembly Health Committee and was referred to the Appropriations Committee where it stands today.