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Health Reform and the Year of Magical Thinking in California

By State Senator Sheila Kuehl
Chair
Health Committee

The Year of Magical Thinking is the title of a memoir by Joan Didion detailing her state of denial, inexplicable behaviors and, finally, coming to grips with, the death of her husband. It’s also an apt description of the Governor’s 2007 approach to reforming our broken healthcare system, with the glaring difference that he still hasn’t come to grips with the truth. (After all, if a complicated movie plot could be resolved in less than two hours, who not fix healthcare in California in nine months?)

Beginning in January, the Governor ordered his health advisors to sketch the outlines of a plan that would magically “cover” all Californians by simply requiring them to buy health insurance. To this moment, he has refused to negotiate any of his major points with the Legislature. The language for his plan was finally drafted five months later, and shown, under wraps, to a few, select people. Not one legislator agreed with it, and no one would carry the bill as legislation.

To fill the void raised by the Governor’s magical “we must do something this year” drumbeat, the Democratic leaders began crafting their own reform plan. To date, however, the Governor and the Legislative leadership have remained oceans apart on the broad policy strokes of health care while public support for the current insurance-company controlled system has plummeted and support for the reforms contained in SB 840, the Medicare-like fix for California, has grown.

Now, with less than two weeks remaining in the first half of the two-year legislative session, there is still no “something” on the table and the Governor, like a Barnum and Bailey’s ring leader, continues to announce that he will, assuredly, pull a rabbit out of a black hat. Actually, there is no way of knowing if the result would really be a rabbit; it could just as easily be an albatross.

The Governor has further limited discussion by announcing that he would veto both of the legislative proposals that have actually been introduced as real bills. SB 840, by far the most carefully crafted, transparent and fully vetted bill, will remain in the Legislature until next year, since sending it down to him for a veto would end any consideration of single payer until 2009. The individual mandate provisions in the Governor’s pronouncement are being emphatically rejected by virtually all stakeholders representing the people who would be forced to pay uncapped premiums. The percentages to be paid by employers and individuals, hospitals and doctors, people in a “pool” and those outside, those above differing percentages of the poverty scale and those below, are so far apart in the Governor’s pronouncements and the Speaker’s bill, you could drive trucks through the gaps. The Governor’s lynchpin financial mechanism of a provider tax remains submerged under the very murky water of a 2/3 vote. What convoluted compromise might be devised in a last-minute attempt is anyone’s guess.

Nonetheless, we are told that, unless we agree to pass a yet-to-be hastily drafted bill that incidentally may be the biggest reform proposal ever attempted in health care, and pass it in two weeks, thus completely bypassing the entire political process and any semblance of open public input, we’ve completely failed and health reform is doomed forever. Please.

The prospect of legislative staff, sitting behind closed doors, hastily crafting a 100-page health reform “compromise”, to be pushed through the legislature with little or no public input over the course of the next 14 days, is deeply irresponsible. Frankly, given the example of the energy deregulation bill, we ought to know better.

Moreover, we lose nothing by taking advantage of the fact that the sessions of the California legislature are two year sessions. Many of our major accomplishments, most recently, AB 32, the bill related to greenhouse gas, took more than one year to achieve. Next year’s Presidential campaigns will ensure that health reform stays as the top of the agenda. More importantly, the issue of health reform will continue to dominate because the people need it and want it. What they want, and deserve, however, is responsible health reform, not a new debacle that benefits the health insurance companies the way the electricity bill benefited Enron.

Finally, we must not forget the reason that we are in this crisis to begin with. Health care premiums changed by insurance companies continue to grow 3-4 times faster than wages. A solution is needed that pays attention to adequate funding, affordability, cost controls and quality.

Even if the Legislature should pass a last minute convoluted experiment in health reform, there will still be a need to continue the work to enact a fully vetted, Medicare-like single payer system that replaces the insurance companies with a plan for all Californians, allows each person to choose their own providers, and protects affordability, comprehensive coverage and quality. Such a solution is the only sensible and tested way to achieve universal health care responsibly. Whatever happens in the next two weeks, the movement for single payer universal health care is continuing to grow, and SB 840 will continue as its focal point, the only legislation that establishes the kind of truly universal, modern and affordable health care system the people of California need and deserve.

Senator Kuehl is the author of SB 840, a "Medicare for All" approach to California's health care, which passed the legislature last year only to be vetoed by Governor Schwarzenegger. It has been reintroduced this year and is making its way through the legislative process, having passed the Senate and pending in the Assembly for a floor vote.

Posted on August 31, 2007

Comments

I have given it some thought and it seems that the only way to make congress move quickly on tax supported national health care for all is to demand aggressive endorsement and passage of John Conyers Bill HR 676. Medicare for all. All of you need to get on the phones , the email, and every other way possible. Get your friends, and family to help also. This is not a Democratic, or Republican issue. Its an American issue that effects everyone. Demand, and harass your representatives. Federal, State, and local. Demand unequivocal endorsement, and support of HR 676 Medicare for all. And if they drag their feet, or fail to quickly support this bill. Tell them you will do every thing in your power to see they don't get reelected if they don't. No excuses about we cant afford it. Many knowledgeable reputable experts have clearly shown numerous ways we can easily afford it. We already spend more on health care than any other country in the world. We cant afford not to have National Health Care for all. Look at www.sickocure.org

American Citizens are ask to step forward for the American people, and National health care for all. And target, and run against every politician that does not sign on to aggressive endorsement, and passage of John Conyers Bill HR 676. On a platform of National health care for all, Now! Each representative will be given a DEADline by which to respond in writing. Those that do not respond. Or that do not endorse immediate passage of this bill with full veto override if needed will be targeted for removal.

This can be done people. This is your duty. Hopefully you wont have to run, or serve. But you must be willing to do so. If you have to. It's time for the real American patriots to step forward. America, and your fellow citizens need you. The old people. The young people. The children. The babies all need you. You must start now. You must be aggressive, and relentless. You must not tire. You must take good care of your-selves so you can fight tough. Millions of life's are at steak. The time is now. You must not fail people. Some of you who have been wiped out by illness, and medical bills. You can do this. If you get elected to the house, or senate you'll have good health care coverage. BY GOD!!!! Actors, artist, every day people. Mother's, Fathers. Young people. You can do this.

Don't be distracted. There are paid teams out their that will try to distract you from this. Don't let them. Don't let world events, or new tragedy's at home distract you. Health Care is the #1 concern of the American people. Flood the media over the weeks and months till passage of National Health care. Make sure every discussion, and argument is about National health care. You can do this America. YOU CAN DO IT!!!!

And be strategic. If you have to run and another candidate looks like he or she will have a better chance of a win than you. And if they support non-profit, tax supported, single payer, National Health Insurance. Then drop out at the right time. And throw your whole hearted support to them. On the other hand. If you had to run because the politician in power failed to support passage of HR 676. Then do every thing in your power to win, and to see that they don't get reelected. Even if several of you have to run to take him out. Remember this is not a democratic, or republican issue. It's an American issue. We don't really wont their job. We just want good National Health care for all Americans. Be tough. Be brutal if need be.

Below is a reminder of just a few of the reasons why our current system of health care must end. And be replaced with non-profit, tax supported, single payer, National Health Insurance.

To our friends around the world. We welcome your help, and advise. Don't be offended by the people that lash out at you. Or tell you to mind your own business. They don't really speak for most Americans. We, America is a part of all of you. We need your help, and advice. And we appreciate any input you have to help us solve our health care crises.

Love...

Posted by: jacksmith at August 31, 2007 09:32 PM

You are all in this together. Whether you have the finest full coverage health insurance. Or no insurance at all. Whether you are the President of The United States, senator, or congressman. Or a premature infant in some inner city icu struggling for your life. Your medical care has been severely compromised by greed, and the profit motive. And in medicine, compromised care means injury, disability, and DEATH. All because the very core of American Medical health care has been compromised through the medical practice guidelines.

Guidelines that should be based purely on unbiased, open, transparent medical science. And open, unbiased, transparent, well documented, scholarly, scientific, clinical experience. All focused solely on the very best interest of individual patients. And tempered with the ancient wisdom, and warnings of Hippocrates, "To Above All. Do No Harm". Only non-profit, tax supported, single payer, National Health Insurance can fix this disgrace.

The moment of truth has arrived. Save your-self. And save America along with your-self. Act as if your life, and the life of your loved ones depends on it. BECAUSE IT DOES!!

GOD BLESS AMERICA.

YOU CAN DO THIS AMERICA!

Love...

Posted by: jacksmith at August 31, 2007 09:49 PM

I think our Governor is no where near serious about Universal Health Care. If he was he wouldn't suggest taxing doctors and hospitals more. With all of the expenses involved in running an office, specifically having to staff a billing department to combat insurance company's denials of payment, refusals to pay and unjust delays, extra taxes on our heads won't help us to deliver the care our patient's deserve.

Nothing in his proposal will do anything to reduce those denials. In fact, I see his idea as a nod to insurance companies to rake the doctors and patients over a new batch of coals.

HR-676 and SB-840 are honest pieces of legislation that hold real promise of producing lasting change. Reducing the profit in medicine doesn't mean punishing the doctors for doing the good work. It means not letting the health insurance industry be a medium for profiteering at the expense of patients. It is high time that the conflict of interest inherent in the health insurance industry come to a stop.

Posted by: Dr. Laurent Colvin, DC at September 1, 2007 12:50 AM

"For some time, I believed that in the absence of congressional action, state initiatives held the key to health care reform. ... It now appears doubtful that states can effect health-care reform."
--Spyros Andreopoulos
San Francisco Chronicle, August 30, 2007
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/08/30/EDDGRQF1A.DTL

Posted by: Eric at September 3, 2007 09:46 PM

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