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A Nunez-Schwarzenegger Compromise or Single Payer for California?

Don McCanne, M.D.
Senior Health Policy Fellow
Physicians for a National Health Program

Last Tuesday's article from Health Access California, a supporter of AB 8, provides an overview of the legislation and the political activity taking place around it. For those interested, it is worth reading.

In a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.

Not one Republican voted for this compromise, and Blue Cross of California is spending a couple million dollars in an advertising campaign opposing reform. So much for compromise. The Democrats have violated the first rule of negotiation. Before they even seriously sit down with the governor, they have removed from the table the most important polices that would bring comprehensive, affordable, high quality care to everyone.

When you read through AB 8, perhaps the most glaring defect is that the authors craft reform around the private insurance model - a model that served us fairly well in the last century, but one that has now become obsolete. Individual private insurance plans that are reasonably comprehensive and include everyone are no longer affordable for the majority of us. The model for this century is a universal risk pool that is equitably funded.

A report in the current issue of Health Affairs stated that the average annual premium for family coverage is now $12,106. With a median household income of $48,200, those numbers no longer work. Do we provide large government subsidies for a majority of us to purchase administratively-inefficient private plans, or do we reduce the benefits of the plans so that the premiums become affordable? The current anti-tax political environment makes the former highly unlikely.

AB 8 will result in an explosion of the fastest growing problem in health care today: underinsurance. Private plans with affordable premiums but inadequate coverage will create financial hardships for precisely those individuals who should be protected - those who need health care.

Most of us who continue to advocate for a single payer national health insurance program have also supported incremental improvements as temporary measures until we can achieve the reform that we really need. But the line must be drawn with AB 8. We need health care financing reform that enables patients to access the health care system without being exposed to financial hardship.

We need a universal risk pool that is equitably funded and efficiently administered so that funds can be redirected to the health care that we need. What we don’t need is false pride in having protected the private insurance industry at the cost of leaving millions of Californians without adequate coverage.

Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 14,000 members and chapters across the United States.

Posted on September 17, 2007

Comments

I am 100% behind Dr. McCanne and Single-Payer Universal Health Care. This is what Michael Moore in SICKO shows can be and is done in other countries like Canada, Great Britain and France. There is no reason it cannot be done here. By eliminating the middlemen (i.e. health insurers) we can more than fund health care for all and for much less money. We will wind up with a healthier society from which all will benefit. This is also what Dennis Kucinich is proposing—but those "Democratic" politicians being backed by Big Money do not want what is good for you and me.

Posted by: Yvonne Steffen at September 18, 2007 05:37 PM

The answer to improving our health care financing lies in shifting away from employer provided benefits to individual policies. This is how we obtain auto insurance and it works quite well.

Those who do not pay for their own insurance do not know its value. Most of the perceived inequities of the current system stem from the individual’s lack of control over their insurance coverage. The grocery workers strike a few years back is a good example of this. Strikers were motivated to great sacrifice by the relatively small benefit changes proposed by management.

Health care cost shifting, high premiums, and the uninsured are all problems that can be addressed by shifting purchasing power to individuals. Perhaps this solution has been ignored because it doesn't advance any political careers or promise something for nothing to any subgroup of our society. It would work though, because it is fair.

Posted by: Fred Ziegler at October 19, 2007 03:22 PM

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