Out Of Their Minds: Healthier Healthcare?

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Healthier Healthcare?

With millions of Californians going without healthcare coverage, Gov. Schwarzenegger and other state leaders are expected to come up with a new healthcare reform proposal in 2007 that will expand access to affordable insurance throughout the state.
    In recent years, various proposals have included requiring employers to provide coverage to all employees or creating a Canadian-style, single-payer system where all residents pay into a new government agency that provides healthcare coverage to all. One of the most recent proposals to come under scrutiny is a program created in Massachusetts that requires all individuals to have healthcare coverage, while providing it at low or no cost to low-income families.
    Anthony Wright is executive director of Health Access California, a Sacramento-based, nonprofit organization that seeks to expand access to affordable healthcare for all Californians. Jot Condie is president and CEO of the California Restaurant Association, a group that has fought efforts to place the financial burden for expanded healthcare coverage on employers.
    Harrison Sheppard takes the pulse on this timely issue.

Anthony Wright
Executive Director, Health Access California
health-access.org

How many Californians have no healthcare insurance?
“California has more than 6 million to 7 million uninsured people. Californians are more likely to be uninsured than residents of 45 other states.
    “Californians are less likely to be offered healthcare coverage on the job. This is noteworthy, because more than 80 percent of the uninsured are workers or family members of workers. So these people who end up uninsured are people who pay their taxes and play by the rules but do not get coverage on the job, do not qualify for public programs and find insurance is either unaffordable or unavailable.”

So what should be done about it?
“The Legislature has, in the last four years, put forward multiple ideas that we have supported.
    “In 2005, for example, there was a bill (AB 772) to expand our Medi-Cal and Healthy Families programs to at least make sure that all children are covered, are healthy and ready to learn.
    “In 2006, the Legislature passed SB 840 by Sen. Sheila Kuehl (D-Los Angeles) to create a universal healthcare system for all Californians, to replace the complex and confusing insurance mess we have now. Gov. Schwarzenegger vetoed both bills.
    “A couple of years ago, they also passed a bill on a minimum standard for on-the-job healthcare benefits. Gov. Schwarzenegger campaigned for its repeal by referendum, which passed narrowly. We’ve had proposals in this state for several years. It’s time to act, because the status quo is not an option for consumers, businesses or health providers.”

Given that the governor has vetoed healthcare measures, do you think he is sincere about getting a good plan passed this time?
“The issue isn’t sincerity, it’s action. We will see what the governor proposes and how he proposes to do it.”

Would you favor a universal system that provides coverage to undocumented immigrants?
“Fundamentally, if you’re trying to extend coverage to all Californians, it doesn’t make sense to exclude specific populations. From a basic public health point of view, a disease does not recognize a difference in people’s citizenship status. And more important, if somebody is working here and paying taxes into a system, they should get the benefits of that system.
    “In a single-payer system, if people are paying taxes into a healthcare system, they should not be denied that benefit.”

Massachusetts recently passed a major healthcare reform. Would this approach work in California?
“The specific structure of the Massachusetts proposal would not work in California because we’re a very different state with a different population, demographics and systems.
    “We’re starting from a different place. Massachusetts has close to 10 percent to 12 percent uninsured. California has 18 percent to 20 percent uninsured.
    “They’re trying to close a gap. We’re trying to jump a chasm.”

Jot Condie
President and CEO, California Restaurant Association
calrest.org


Advocates of healthcare reform believe there is a healthcare crisis in California. What do you think?
“There are too many uninsured California residents. But there are two crises going on here. A large part of the uninsured problem in California is a mere symptom of the main crisis, which is the out-of-control costs — the double-digit increases in healthcare insurance premiums over the past five or six years, and the impact it can have on the business community.
    “Since it’s not mandated for employers to provide healthcare to their employees, they unfortunately have to make tough decisions when it looks like they can’t stay in business if they continue to provide health insurance.”

Who do you think should pay for increased healthcare coverage?
“To the extent this is a societal problem that ought to be a cost that is borne by society.
    “The only way to get to society is not through institutions. Some people may be part of some institutions and others may not. It’s individuals. That gets into the tax issue.”

It sounds like a single-payer system.
“The notion of single payer is a medical delivery system that is flawed in almost every way. The quality of service is poor. We’ve got a lot of quality healthcare in California, but it’s expensive.
    “At the end of the day, who pays for a system should probably be more akin to the funding mechanism for a single-payer system. We just don’t think the delivery of services ought to be done the way the delivery of single-payer is done, where the government controls everything.
    “Whether it is a fee-for-service or just a tax on products that society buys, to the extent you can assure payment is borne by everybody so the pain is less acute, then the system becomes something where you don’t have a particular special interest trying to undercut the effort.”

So you’re saying all taxpayers should share the costs, but the government shouldn’t run the delivery system?
“Yes, but there are always strings attached. If the government is collecting the money, they’re going to want to have some oversight.”

What about an employer-mandate proposal?
“You disproportionately put a burden on one segment of society. You’re providing people a job, now we’re going to mandate you provide healthcare insurance. Because the cost of healthcare insurance is so high, you’re going to see something akin to what you saw when workers’ compensation was spiraling out of control, and many small businesses were on the verge of going under.”

What do you think of the Massachusetts proposal?
“Of all the proposals that have been floated, that seems to have the most promise. They seem to have cobbled together a coalition of special interests and different political ideologues to come up with what has been termed an “individual mandate.” The devil’s in the details. What they did in Massachusetts was create a shell of a proposal and punted all the details to regulatory entities to figure out how it would be implemented.”

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