(Apologies to the Thers at Whiskey Fire for stealing his gimmick of using a Guided By Voices lyric as a blog title)
I feel like there are two completely different conversations happening on the major issues of the day in California. In one, there is an historic opportunity to provide quality health care to everyone in the state, which will be affordable and comprehensive
and go a long way toward solving our numerous health care problems. In the other, the state is completely in the fucking toilet
and nobody in a position of power has the political will to do anything about it.
Now the governor finds himself in a predicament similar to that of his predecessor, Democrat Gray Davis: staring at a crippling budget shortfall that threatens to overshadow all other business in the Capitol and tarnish his political legacy.
On Monday, Schwarzenegger ordered all state agencies to prepare plans to cut spending across the board by 10% next year. Education, transportation and healthcare will all be affected. Some programs face elimination. Layoffs may loom. The state's budget shortfall, thanks largely to the troubled housing market, has ballooned from a few billion dollars projected at the beginning of the year to $10 billion.
Experts are not surprised.
"There has been lots of talk and lots of gimmicks, but none of the state's underlying budget problems have been dealt with," said Ryan Ratcliff, an economist at the UCLA Anderson Forecast. "Even in the middle of a revenue boom, we kept spending more than we take in."
Spending has increased, but the issue is structural. There's no way California can meet the needs of its burgeoning population under the draconian revenue and spending structure we have in place, and the Governor has made no moves to fundamentally change that, just to pass the horror show on to whoever replaces him in the most hacktastic manner possible. Here's Kevin Drum
Four years ago Arnold Schwarzenegger took office in the midst of a massive budget crisis after promising voters that he would end our "crazy deficit spending." In true Republican fashion, he did this by immediately reducing the state auto licensing fee by $4 billion a year and then insisting that we all approve $15 billion in bonds to paper over a shortfall that was now even more desperate than the one he inherited. The hope, apparently, was that nothing bad would ever happen to the economy and eventually we'd squeeze out from under the rock we were under.
I opposed the bonds at the time, and I've never regretted that vote since. Defeating the bonds would have caused immense fiscal pain, but it would also have forced Schwarzenegger and the legislature to actually fix our underlying problem by increasing taxes and reducing spending. Our nonpartisan legislative analyst made it clear from the beginning that Arnold's plan had no long-term chance of success, but he just flashed that million-dollar smile and went ahead with it anyway.
And now we'll be paying for years and years to come, with ENORMOUS pain just down the road when the bonds come due. And we're talking about providing universal health care?
The plan itself has significant things to feel good about
, even if it is only a first step. It includes an individual mandate, but with all of the affordability exemptions, it's not a mandate at all. It expands public health services as much as any reform since the creation of Medicare and Medicaid. And there are excellent reforms like guaranteed issue and a modified community rating for cost control. Obviously there are questions about what minimum coverage provides but the affordability requirements, capping out of pocket costs at 6.5% of income, should be a mitigating factor.
But the entire discussion is happening in some kind of alternate universe of fiscal health. The 10% across the board cuts will impact health care, particularly any public care options; is AB X1 going to account for that? The convoluted funding mechanism, which will need voter approval because the 2/3 system for tax increases is still in effect, includes 8 core parts, including "federal matching funds" and "reinvested state savings." Why don't you just add a pony, too? We're heading into a time where the state could be as much as $10 billion in the hole. The new entitlements will be the first ones crowded out by a governor wedded to anti-tax ideology. And he hasn't signed on
to a new cigarette tax, by the way, still preferring PRIVATIZING THE LOTTERY, and the net income increase from which will be approximately zero dollars in the long term, at best.
And let's not gloss over the ballot-box hurdle such a plan would have to scale. Maviglio soft-sells
the defeat of a tobacco tax to pay for health care in Oregon yesterday, saying that California's different, conveniently forgetting that Prop. 86, which was, um, A TOBACCO TAX TO PAY FOR HEALTH CARE, failed miserably here just last year. In fact, the Oregon ballot measure wasn't the only one
that a tax-averse, skittish electorate rejected yesterday.
Cost-conscious voters rejected school vouchers for Utah students, state-sponsored stem cell research in New Jersey and increased cigarette taxes in Oregon to fund health care for uninsured children.
New Jersey voters had not killed a statewide ballot measure since 1988. The rejection was a defeat for Democratic Gov. Jon S. Corzine, who campaigned heavily for the plan to borrow $450 million over 10 years to finance stem cell research.
"The public understands the state has serious financial issues that must be addressed first," Corzine spokeswoman Lili Stainton said.
No state has more serious financial issues than California right now. And voters are listing the economy as a greater concern than Iraq
at this point in time. Ballot-box budgeting ends up producing results that are popular but not necessarily effective. Painful solutions regarding revenue and spending are the only way to dig us out of the mess the so-called leaders in Sacramento have created, and voters aren't entirely likely to be informed and sanguine enough to pull the trigger on that.
This is why I continue to maintain that universal health care ideas on the state level are doomed almost by definition
, and particularly in a state with the looming budget troubles like we have here.
The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house—in this case the insurers, the providers, and other agents of the status quo—always wins. The new raft of reforms may prove different, but they probably won’t. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will [...]
One of the great things about state governments is that they have more freedom than the federal government does to test new policy ideas. But it pays to look honestly at what the results of those tests actually say. And in this case, the results are pretty clear: states are no good at delivering universal health care.
No one can doubt the role Massachusetts and California have played in reinvigorating the debate over national health care. And if the reforms currently percolating at the state level help provide momentum for a national health care system in the next few years, all the effort will have been worth it. If they don’t, however, they may ultimately prove detrimental. If high-profile efforts like those in Massachusetts and California can’t be properly implemented, or are launched and then collapse, they’ll become powerful weapons in the hands of protectors of the status quo.
There is a world in which bad policy ideas can actually be worse than now policy at all. We have to tread very lightly and ensure that doesn't happen in California.
Labels: Arnold Schwarzenegger, budget, California, cigarette taxes, economy, health care, initiatives, universal health care