Back In The Game

The debate over health care in California will define how the debate will go nationwide. Today Sen. Shiela Kuehl submitted SB 840 once again to a legislature which passed it last year. It is the only plan being debated in Sacramento right now that offers real reform of the health care system. Dan Weintraub tells us why the other plans, from the governor and the Democratic leaders in the legislature, are insufficient.

As Gov. Arnold Schwarzenegger and legislative leaders start haggling over how to broaden access to health insurance coverage for millions of Californians who lack it today, they will mostly be talking about tweaking the existing system. Though their plans have major differences, the governor and his legislative counterparts all want to preserve and expand the employer-based system as we know it, mainly by forcing more companies to buy private insurance coverage on behalf of their workers.

If you think the current system works pretty well, then you probably think this is the right approach. A few subsidies here, a mandate there, a new tax or two and we're done. After all, more than 80 percent of Californians have health insurance of one kind or another already. Why mess with a good thing?

But Schwarzenegger and the legislative leaders -- Senate Leader Don Perata and Assembly Speaker Fabian Núñez -- say that our health care system is in crisis. That diagnosis begs the question: If our current system is failing so badly, why add millions more people to it without fundamental change? Should we be trying to shore it up, or should we just chuck it and try something new?

Weintraub thinks the key is cost control and containment. This is true, and there's no more efficient a system than Kuehl's single-payer approach. We don't strive for the big things in America anymore; incremental approaches and change by inches are seen as the only things which are politically viable. I understand well that politics is a game of compromise, and that the most likely approach to get real progress on health care is to put the private for-profit insurance industry in competition with a public system, forcing insurers to provide better care or be simply pushed out of existence. However, while politics is the art of the possible, it's extremely important to dream the impossible, to push the needle of where the possible can land.

The alternative proposal, offered for the third year in a row by Sen. Sheila Kuehl (D-Santa Monica), would create a state agency to pay for medical treatment for all Californians. Doctors and hospitals would remain private entities.

Financed by taxes on payroll and income, the plan is presented by proponents as a panacea, providing everyone with more and better care while saving most families money by eliminating much of the administrative cost of the current healthcare bureaucracy.

A 2004 study by the Lewin Group, a consulting group whose other work has been cited by Schwarzenegger's office, estimated that the plan could extend coverage to the 6.5 million Californians without insurance while saving $8 billion, or 4% of healthcare spending in California by individuals and businesses.

Single-payer actually saves both California citizens, businesses and the state money while providing quality care for all. There is no reason this should be a third rail. We know that health care spending is set to double over the next ten years under the current system. We know that the vast majority of Americans want health care for all, and would PAY HIGHER TAXES to get it. There is no earthly reason we should be putting together these piecemeal, don't-offend-the-insurance-industry deals that preserve a failed system.

I'm very pleased Shiela Kuehl has brought her proposal back for a third straight year, and I hope that it will get us to some compromise on health care which is both possible and progressive. We should not have to choose.