Squeeze Play: The California Democratic Health Care Compromise to Be Unveiled Today

As someone currently uninsured, I do not see this as a positive step. Too many people function under the false assumption that health insurance = health care. It does not. Many people who have had health insurance find that their insurer will deny their claims, or prevent them from getting necessary health care. There appears to be nothing whatsoever in this compromise that addresses this fundamental problem.

Further, how will the mandate be affordable to individuals? The only way that is possible in a market dominated by for-profit providers is through junk insurance - low premiums that do not carry many benefits and come with high copays. Massachusetts has not been able to provide affordable premiums, and as a result many are still uninsured - and still more are seeing their budgets busted by the mandate.

Even 6.5% of one's income is a high amount. You remember the recent California Budget Project study showing how expensive it is to live in CA - 6.5% of family is not something many families can afford.

We who are uninsured do not have much of a voice in this debate. Many of the health advocacy organizations are not sufficiently critical of the health insurance = health care assumption, or not fully aware of how the costs of a mandate would crush our wallets, or too enamored of the idea that "getting something done" is more important than "getting it right." We are uninsured not by lifestyle choice but by economic necessity. If there are no guarantees of both affordability AND care (because affordable is worthless without real care options to go with it), then why should we support this?

I can only hope that rank and file Democrats reject this compromise, that the coalition of groups promoting health care reform reject it as well - otherwise we'll have to vote against the financing package in November 2008 to ensure that the mandate to purchase insurance dies.

I am deeply disappointed in Democrats for caving on this. I want health care. Not a law making me hand money I don't have over to insurers who won't give me care.

Thanks, Robert. You raise valid concerns. We will have to see how they are addressed in the proposal and to what extent. A lot of this depends on the subsidization for those of limited to even average means and the tax credit. Someone will have to pencil this out--and if there is "junk insruance" allowed--wth high deductibles--that cost has to be included. That and the employment related features of the bill versus the how those who are independent contractors or not employed works out needs to be really looked at.

I favor single payer becuase of the lower overhead and admninistative costs, and because I don't see the benefit for the up to 30% of premium dollars spent on these costs and profit for insurance carriers gets us.

In any system, someone has to make decisions as to what will be authorized and not. I know this all too well, having spent a quarter of a century as an attorney trying to get medical care for injured workers and seeing all sorts of delays and denials that were eventually reversed when matters got before a judge--medical care delayed is medical care denied. Are there provisions in the bill or ways of enforcing existing laws so this doesn't happen if it becomes law?

That's what I will want to see. And I for one would like to look at all of this and analyze it carefully before passing judgment.

Democrats passed AB 8 earlier this year and last year passed SB 840. Both were vetoed by the Governor. There seems to be little that can be done to persuade the Governor to go with single payer--or a more aggressive version of what the Dems have supported in the past, which could include a blended version or one where you are offered a choice between single payer or private insurance--where competition should make single payer eventually the choice of most.

We don't have that--and that rests squarely at the doorstep of the Governor and the Republicans in the legislature. The last health measure by Senator John Burton was killed in a close referendum where the other side spent tens of millions. It's a sad commentary if this compromise approach fails by such a process or for any reason we get nothing done this year and session. It will also be sad, if upon reflection and analysis, this bill is not a significant advance. Other than doing nothing, I don't know what Democrats can do here--as they need a measure the Governor will sign and that will not be easily defeated in a referendum or other ballot prop contest. that's the nub of the matter.

Again, I think it is worth looking at Massachusetts' example to see the flaws of this system. They've not been able to provide the promised affordability, and the lowest-cost plans come with high deductibles and limits on what kinds of care are covered.

As a result, a large number of their uninsured have simply evaded the mandate and will take their chances with the law. California has a far larger number of uninsured, both absolutely and proportionally, than Massachusetts, which suggests unaffordable premiums that lack guarantees of care may not provide the promised benefits.

So I am deeply skeptical of the concept of individual mandates, not just because I prefer single-payer, but also because I don't think MA provides a reassuring example. As you wrote about here last week, Health Access California put out a fact sheet comparing CA to MA in terms of health insurance reform, and noted that CA insurance is "more lightly regulated" than in MA. Without seeing evidence of further reforms, to discuss the problems both you and I raised, I don't see the individual mandate proposed here as being desirable.

Finally, I do not believe the desire to get something done should outweigh getting it right. Even as someone without health insurance, who winces figuratively and literally at every minor twinge of pain, I would prefer the status quo to a deeply flawed program, especially when the economic security of so many families is threatened (via the individual mandate). While the details of this compromise are important, what we have learned so far is not encouraging.

What's wrong with a ballot initiative for SB 840? Put it out for the people to decide, once and for all!

Nick: The only problem is one of money and the fact that it is more difficult to get a yes vote on a ballot prop than a no vote.

Prop 72, Burton's requirement that employers provide health insurance was passed by the legislature and employer groups got the signatures to get it on the ballot as a referendum where with a ton of money it was defeated.

It takes about $2 million to get on the ballot and then multiples of that to pass a ballot prop. You'd be looking at upwards of $100 million from insurance companies and a whole lot of other businesses against SB 840 on the ballot.

So a ballot initiative is not a piece of cake. What is these days?

I guess I am just remembering the ballot initiatives of the 1970s or 1980s fondly.

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