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Can Californians Reason Together on Where We Go From Here on Health Care Reform?

By Frank D. Russo

In the wake of yesterday’s defeat in the Senate Health Committee of AB 1X 1—a compromise bill between Speaker of the Assembly and Governor of California—and barring a miracle, California will not see comprehensive health care reform this year. There’s just no other way to make sense out of the bills in the legislative hopper, the negotiations that have taken place in the last year, and sifting through the welter of statements made after the committee’s vote, many of which we will be posting soon in a separate article.

Try as he may, Speaker Fabian Nunez’s characterization of AB 1X 1 as a “bipartisan” bill is illusory, unless bipartisanship means having one Republican (Arnold Schwarzenegger) supporting it and all Republicans in both houses of the legislature (without exception) opposing it. The bill was passed by the Assembly solely with Democratic votes.

Strip all the rhetoric aside consider the fundamentals of how legislation is enacted in California and how they played out with this health bill and any others that will come after it. You need passage by the legislature and a signature by the Governor. Refine that a bit, and include the proviso that anything signed into law can be held in abeyance if signatures are gathered for a referendum—which any powerful interest can secure with a couple of million dollars. Then you have an election on a ballot proposition, where more millions of dollars and negative advertising make it more difficult to get the voter’s approval.

It’s like one of those games where you maneuver a round object through a maze and if it falls through a hole you have to start all over again. As I described the different twists and turns of health care bills this year to my wife, a nurse by training who has followed this issue for decades, she told me that one issue or another was not entirely new and we had been discussing combinations of each since the 1970’s.

We’ve been down this road before in California. With a Democratic Governor, Gray Davis, the legislature passed SB 2 by John Burton, President pro Tem of the Senate in 2002, which would have created a $7 billion system providing health insurance to all working in Californians through their employer. The referendum against that, Prop 72, albeit by a narrow margin, killed it.

While most of the comments from Democrats and Republicans in the Senate Health Committee yesterday were complimentary of the efforts of the Speaker and the Governor—and of the process—there still is a very negative and poisonous residue from the attempt to cobble together a compromise. And I am not speaking of the reactionary forces that are truly opposed to real advances of any sort in the health care field.

The sniping on the left side of the spectrum--between proponents of single payer and the Speaker and others favoring compromise has been painful to watch. It has devolved into a nasty and personal set of accusations and counter charges. Good people who want to see more people have access to health care and who disagree as to tactics, strategy, and approaches—and who have significant differences—have not confined themselves at times to the merits of the proposals.

I am not interested in who threw the first rock—this goes both ways. I’d like to have a heartfelt family discussion as to where we go from here with frank acknowledgment that the hand that we have been dealt is a difficult one to play, and somewhere between single payer and the amalgam of the Nunez-Perata and Schwarzenegger proposals is where we need to go—if that chasm can be bridged. If not, we wait for a new governor (3 more years), an initiative placed on the ballot by signatures of the people (who despite everyone’s citation of polls to support their favorite plan are enough divided that passage is dubious), or a new President and effort nationally (but remember 60 votes in the U.S. Senate are needed for countrywide reform).

Given the conceptual proposal made by the Governor a year ago in January which was only much later put into legislative language in a bill that did not have a single solitary supporter in the legislature, Democrat or Republican. Given the Governor’s veto of SB 840, Senator Sheila Kuehl’s single payer bill in 2006. Given the veto that is sure to be wielded by Governor Schwarzenegger if and when the legislature passes SB 840 once again in 2008, I don’t see how one can fault the motives of the Speaker of the Assembly Fabian Nunez in trying to get traction on a bill the Governor would sign.

I understand the debate about whether the final product was one that deserved support and questions about strategy and tactics. But I don’t, for the life of me understand how this could have played out differently in 2007 and how it will in 2008. It certainly was not for want of effort on the Speaker’s part. He could have more easily said it just wasn’t going to happen and quit trying—but he surely would have been criticized for that.

There have been some strange bedfellows on this one this year. I received quite a few interesting emails and calls from my friends at the California Nurses’ Association and the Foundation for Taxpayer and Consumer Rights rightly characterizing the final bill as one supported by most of the insurance industry. From the other side came barbed comments about some of these progressive groups being aligned with big tobacco, Blue Shield, and the like. It was interesting to see some derisively call the final bill the Schwarzenegger bill as if the very name should cause one to oppose it.

The enemy of my enemy may be my friend. But politics is the art of the possible. One makes progress on a big and contentious issue such as health care reform where large amounts of money are at stake by splitting the opposition. This one fractured all around. Labor and progressive groups were split. Consumer groups were split. Business and other powerful interests generally opposed to any advances on government doing anything were split.

There are others who will cast blame. I am not Pollyannaish about the politics here. And I acknowledge that the situation is not entirely pure and simple. It is messy, as politics often is. But I wish my friends—all of you—could try to find the best in those you have said some harsh things about and recognize that we need to work with each other if we are to have any chance of making progress.

Behold the turtle. It makes progress only when it sticks its neck out.

Posted on January 29, 2008

Comments

The idea that the current best friend to a single payer health care system (ala SB 840) could be big tobacco is kind of perverse. But if we can strip the devil of his robes and use them to strangle the life out of the for-profit-death- assurance industry I am all for it.

Fabian's cobbled together economic nightmare was only a thinly vailed attempt to look like he was earning his civic income by producing legislation. There was never any chance it could pass. The holes in it would bankrupt the state - more so - just as ANY plan that keeps the for-profit-health-insurance-industry in place will do.

Go to our website, to the Act Now page, and download the .PDF file that is the complete SB 840 bill and read it. In a few short years we will most likely be in a full blown depression and the governor that will be around at that time may have no alternative but to enact SB 840 or some derivation there of. Wouldn't it be better to do it now and save some suffering?

Posted by: InsuranceTeaseDOTcom at January 29, 2008 06:39 PM

The Democrats on the Senate Health Committee got it right. This bill would have created financial hardships for middle-income individuals with health care needs. Many could not have afforded the premiums alone, even if mandated. Too many would still have been left without coverage. And it would have been politically difficult to repair once in place, because it would have required a much greater role for the tax system.

Building on our current system of public programs and private plans is the most expensive model of financing reform, and it falls short on many policy goals. But it still could have been done had the negotiators insisted on compliance with the rules of health policy science, even if more expensive and less effective.

A single payer system (SB 840) would have been the least expensive model and would have achieved most of the important goals - especially universality, comprehensiveness, affordability and equity. Gov. Schwarzenegger should take another long, hard look at this bill.

Posted by: Don McCanne, M.D. at January 29, 2008 07:44 PM

The "art of the possible" gave us this ABX1-1 mess, one of the worst bills to come down the pike in a long time.Our government is dysfunctional. We are painted into a corner and the only way out is with true leadership. Senator Kuehl has the best plan with SB840 but being best no longer makes it. The Republican's will continue to do what the insurance companies tell them to do. In lock step as we head over the cliff.

Posted by: SylviaBall at January 29, 2008 10:59 PM

I agree with Frank -- the left needs to get together in an honest appraisal of the obstacles to reform and how we overcome them.

Speaking as an insider, I can tell you that virtually everyone who worked for passage of ABX11 understands that single payer / SB 840 is the best (and possibly the only workable) policy solution. I wish the campaign could have said that more clearly.

The problem is that SB840 falls at the first political hurdle, the 2/3 rule, and no-one -- not Andrew McGuire, not Donna Gerber, not Don McCanne, has yet articulated a strategy for turning those 8 Republicans (6 in the Assembly, 2 in the Senate) into "yes" votes on the financing (because it can't be done), or for turning those 8 Republican seats Democratic. In fact, over the last 10 years, the Dems have actually lost more seats than they've gained in the state legislature.

Not to mention that we can't count on all the Dems in the Legislature to support single payer when the vote is real (i.e., includes financing) and not only symbolic as it was last year. There's a significant bloc of Mod Dems, mostly in the Central Valley and So Cal but including our own Leland Yee, who have consistently opposed regulation of the insurance companies and other consumer bills.

And we know that ERISA is a major challenge to any employer-based solution.

So c'mon folks - get off your high horses and come to the table on a "step forward" bill that gets people healthcare NOW and moves us closer to universal coverage. And consider the possibility that single payer may not be come into being all at once, like Athena being born from Zeus' forehead.

Posted by: JesseRoth at January 31, 2008 06:52 AM

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