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Health Reform in California is Like Threading a Camel Through the Eye of a Needle
By Frank D. Russo
I’m skeptical there will be a California health care deal in 2007 or 2008. But I’d be happy to be proven wrong as there is a rare opportunity to get something done that would be remarkably similar to the plans proposed by many of the Democratic candidates for President. The devil is in the details as to AB 1X 1 which will be voted on today in the Assemblhy, but it’s the only game in town for the foreseeable future.
Don’t get me wrong, I’d love to see a single payer plan—SB 840 by Senator Sheila Kuehl passed and signed into law by Governor Schwarzenegger. It was passed in 2006, but vetoed by the Governor. Senator Kuehl could have brought the bill up in 2007 in either the regular or special session, but has chosen not to do so, as it would only end up being vetoed by the Governor. It has the Democratic votes to pass and can be voted on next year before adjournment of the current session. It should be easier to finance than other plans as it would save the 25% to 30% of every premium dollar now paid in California that goes to insurance company overhead and profits. Medicare handles this share of cost for about 5%.
But with this Governor as a fixture for the next three years, single payer is not in the cards until at least 2010—and as is true with any comprehensive health care plan—will be phased in over time and only after a referendum or other vote of Californians on the ballot—whether by proposition or referendum. It would also need as a condition precedent a Democratic Governor willing to sign the bill.
That leaves the question: What do we do in the meanwhile with the millions of uninsured in California including children who lack health insurance coverage? The Nunez-Perata bill, AB 1X 1, that will insure 5 million Californians currently without health care including coverage for every child in the state in 2009 will be voted on today in the Assembly and probably passed. The bill has been called “The biggest public program coverage expansion since the creation of Medicare and Medicaid 40 years ago,” by Anthony Wright, the head of Health Access California, an alliance of over 200 consumer groups throughout our state.
We’ve published wonkish articles by Wright about the bill including a detailed analysis of the amendments to this proposal on Friday and an update of what is expected today to be amended into the bill.
Not that it’s perfect. An article we are publishing today by Donna Gerber of the California Nurses Association, analyzes AB 1X 1 differently. You can read these side by side and get a good view of the differences of opinions amongst Democrats.
It would be nice if the debate on the Democratic side was a bit more respectful, and a little less personal and ad hominen. As Senator Kuehl said in her wonderful floor statement when she voted against AB 8, the Speaker's earlier bill in the regular session, “I know that my colleagues on the other side of the aisle have problems different from my own and will not vote for it. For those who will vote for it on my side, I understand you are voting your hopes.”
Now that the Speaker of the Assembly Fabian Nunez and Governor Schwarzenegger have apparently at long last reached an agreement on a health care plan, labor appears to be badly split on what is in the proposal and Senate President pro Tem Don Perata also appears to be cool to moving forward until the California State Budget deficit is tackled. Unity of labor and the Democratic leadership is needed to pass the funding mechanism for the proposal as a ballot proposition in the November election, where it will be attacked by a well funded campaign from some of California’s business interests and also by others who want single payer or who don’t feel AB 1X 1 goes far enough.
Time is running out to collect signatures to qualify a November ballot proposition. The language for such a proposal, if it has been drafted and vetted, has not been made public.
I say that labor appears to be badly split because of a letter sent by Art Pulaski, the leader of the California Labor Federation, as reported in Sunday's LA Times. The Times has it that Pulaski is asking Assembly Democrats to go against Nunez’s bill and desire and to postpone a vote on it. The bill was amended Friday and is apparently going to have further amendments made on Monday. Now it could be that the Labor Federation will ultimately come out in favor of the bill. But without their full and enthusiastic support, even if it passes the legislature and is signed by the Governor, it is not likely to make that final mile with the voters.
The California Labor Federation is the state’s AFL-CIO network of more than 1,200 affiliated local unions, representing over 2 million union members in diverse communities and sectors of the state. Even with its size and clout, it may not be able to prevent a floor vote on Monday and passage of the bill which will place it in the Senate’s lap. And even with its support, if there is significant dissension within its ranks, it will be hampered when it is needed in November as part of a coalition to persuade California voters.
Senator Perata was fairly emphatic last Friday, saying that it “would be imprudent and impolitic to support an expansion of health care coverage without knowing how we’re going to pay for vital health programs the state now provides for poor children, their families and the aged, blind and disabled.” He praised the substance of the bill itself, saying “The deal itself right now is a much superior deal than I thought they would ever arrive at."
My bet is that Perata, knowing how he operated on the infrastructure bonds last year, has polling that shows him the parts the voters would have to approve are in trouble. He is most probably going ahead with ballot initiatives on water, rather than try to get any agreement from recalcitrant legislative Republicans because of that impossibility and no doubt in light of internal polls he has showing he has the edge with public support.
Trying to pin down the story about whether California will or won’t enact meaningful health care reform approaching universal health care is like driving on a mountainous road with lots of curves. As one rounds each bend there is ever changing scenery. In the last two years, the legislature has passed a single payer bill, SB 840 (2006) by Senator Kuehl and AB 8 (Nunez-Perata) only to see them vetoed. Now, in December at the end of the “year of health reform” we are going around one of those curves.
The one constant in all of this is the lack of even a single elected Republican in the Assembly or Senate to vote for any bill that is really meaningful.
We’ll see what happens later today.
Comments
I think your point about Perata's polling is right on the money (literally). It's difficult to see how the funding portion of this will pass at the polls. We can already expect a knee-jerk anti-tax, anti-useful government vote from the usual suspects here in California, but this will be exacerbated by both the $14 billion deficit (meaning that even more voters will turn against new spending) and the individual mandate (meaning that Democrats and progressives will split instead of unite).
I still do not see why this dramatic and welcome expansion of public health programs in CA has to be tied to an individual mandate. When Congress focused on expansion of public programs alone, in the case of S-CHIP, it received massive public and bipartisan support, getting an amazing 2/3 of the Senate and nearly that in the House. Were Núñez to take the expansion of public programs alone to the ballot it would have a greater chance of success as the Democratic coalition could unite behind it and overwhelm the usual anti-tax sentiments.
It's also troubling that Núñez wants to push this through so quickly. Few Californians even know this is happening, and will have no opportunity to learn about, understand, and give their feedback on the details. That's not only undemocratic, but it's politically reckless - California voters are not going to be pleased to suddenly learn one morning that they're subject to a health insurance mandate that lacks basic cost containment provisions and has risky funding sources.
We can and should help uninsured Californians like myself without putting at risk the financial security of millions more through an individual mandate. Even if this plan is great and workable, it is only right to delay the vote until the new year, so that Californians can become informed and part of this process, instead of shut out by a rapid vote.
Posted by: Robert in Monterey at December 17, 2007 08:12 AM
Robert: You make some very good points here. I don't like legislation passed without adequate public hearing and input--and time to assess what is in a bill. There are several things that ameliorate, but perhaps not eliminate this concern. First of all, there have been hearings all year long about prior iterations of this bill. Secondly, the Senate will not be acting on it until next year--if Perata holds to his prior statement. Third, it will require a vote of the people. But still, it is a concern.
There are other ways to do health care--but apparently not if you want Schwarzenegger on board. Nunez, or anyone else can put together any plan they want to--and either get it passed by the legislature or put on the ballot with signatures. It probably helps a great deal if Schwarzenegger is on board for a public campaign. His support could be the margin of difference as to whether it passes or fails at the polls. Or it could pass or fail regardless.
If he had been in support of SB2, when it was referended on the ballot as Prop 72, given how close that race was, it probably would have passed. Instead, shortly before the election he announced his opposition.
There's a lot that goes into the calculus of whether to go forward or not--and how to do so.
Posted by: Frank D. Russo at December 17, 2007 08:43 AM
Insurance mandates are not universal health care. And politicians should stop calling it that. Nothing is Universal Health Care except "Single Payer Not For Profit Tax Supported Government Managed Health Care" (HR 676). Insurance mandates will be worse than what you have now. And what you have now is a complete, and total disgrace, and horror show. Insurance mandates will (require) you to buy insurance from the private insurance companies that have been ripping you off, and killing you by the thousands.
The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. Contact with the American medical health care system is the #1 risk factor now for injury, disability, and premature DEATH in America. This fact is a catastrophic indictment of the entire US Health Care System.
Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.
This is an emergency. America is in a crisis. And more Americans have died from this health care crisis than have died in all the wars in US history.
But the tide has turned. And the message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that "HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)" is the way to go. Like all the other developed countries have done. Americans want government managed, tax payer supported health care Now. Medicare for all. Like other developed countries have. And like older Americans have now. Accept no substitute.
I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company's that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don't put up with that.
Just look at what is already happening with Massachusetts insurance mandates. It's a catastrophe. Financially, and medically for all the people of Massachusetts. And the private insurance companies just raised their rates by as much as 16%. And everyone has to pay now. It's a slaughter.
It's NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).
Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It's the best way to go on health care. It's the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago. See sickocure.org, and http://www.house.gov/conyers/news_hr676.htm
I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And increase momentum for HR 676 at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.
Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don't be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.
There is no good reason HR 676 cannot be passed into law well before the coming elections. And SCHIP should have been passed by now. Even if it was for 3x the 35 billion congress ask for. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections. This is supposed to be a democracy. And well over the majority of Americans want tax payer supported single payer government managed health care for free for all Americans as a right. Many of the politicians will be soliciting your financial, and political support for the coming elections. Make sure you send a note telling them that you expect them to support HR 676 if they expect you to support them.
Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.
Keep fighting. Pickup that phone, and call your fellow Americans. It's the right thing to do. You will win. Bless you all...
Posted by: jacksmith at December 17, 2007 02:56 PM
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