Clash of the Titans

Mr. Schwarzenegger, meet Shiela Kuehl. She'll be eating your lunch today.

A state Senate panel is expected today to begin the first formal scrutiny of Gov. Arnold Schwarzenegger's sweeping proposal for overhauling health care in California.

Wielding the gavel at the Health Committee hearing will be a member of the Legislature who believes many of the governor's ideas won't work.

State Sen. Sheila Kuehl isn't rushing to judgment. For the past four years, the Santa Monica Democrat has studied health care while pushing California to abolish private insurance and replace it with universal coverage administered by the state. Schwarzenegger last year vetoed Senate Bill 840, Kuehl's bill establishing such a single-payer system.

Schwarzenegger criticized Kuehl's solution as "government-run health care." Now, it's Kuehl's turn to examine the Republican governor's plan, a very different approach that would actually increase the number of insurance customers by the millions.

"My role on these proposals is to to say, 'These are the facts,' " Kuehl said Wednesday. "So far, I think the emperor has some clothes, but not a full wardrobe."

Kuehl is a single-payer evangelist, but important to the debate. She's critiqued the governor's plan (which still doesn't have a legislative sponsor, since there isn't a single Republican that wants anything to do with it) for its individual mandate without cost controls. An individual mandate is important to make sure risk is pooled; if only the sick have health insurance while the healthy can opt out, the price will skyrocket. Indeed, even a single-payer system has an individual mandate; it's just paid for out of taxes instead of fees. But without any sense of basic coverage or what the baseline cost will be or a proper way to subsidize those individuals who can't afford coverage, the individual mandate simply won't work. I agree with Dan Weintraub that individual mandate combined with community rating, guaranteed issue and public/private competition (a state-run "Medicare for All" option for basic coverage) will eventually get you to single-payer by default. But that's not what the governor's plan does.


The most interesting part of the article to me was this:

Kuehl will reintroduce Senate Bill 840, which will be part of the debate this spring. So will health care overhaul bills written by Senate President Pro Tem Don Perata of Oakland and Assembly Speaker Fabian Núñez of Los Angeles, both Democrats. Senate Republicans are also pushing a smaller plan that would rely largely on shifting tax dollars around to cover more people.

Though their bills more closely mirror the governor's approach of covering more people within the current insurer-based system, both Núñez and Perata have also signed on as co-authors of Kuehl's bill. Perata is "encouraging all proposals to be a part of the discussion," explained his spokeswoman, Alicia Trost.

This is the best news I've heard in this debate so far. That Perata and Nuñez are empowering Kuehl means to me that they understand her value in the debate to swing the issue in a more progressive direction. And Kuehl will not give up.

No matter what happens this year to reshape the insurance system, Kuehl says, a single-payer system could still be enacted eventually.

A single-payer system, she said, "is the appropriate end point of health insurance reform in California. But I don't want to force people who are currently in the system who are suffering or lacking in insurance to wait until we have the perfect solution. So we will continue to work out single payer to prepare for the day when we have the right governor or the right initiative atmosphere."

This hearing happened this morning, I'll post some information as soon as it comes in.