Health care and health insurance reform are two of this year’s hot political buttons, and it seems almost every politician across the nation, especially here in California, has a solution. Finally, the people who’ve been reluctant to change have now “discovered” America’s health care problems and are ready to do something. As health care costs eat up more and more of our resources, many people—from politicians, medical care providers and insurance companies to business leaders—agree we can’t avoid the dilemma much longer, either economically or politically. The business community would be wise not to ignore the furor. We must join the debate with constructive solutions that address the major problems. Most important, we must accept the “possible” instead of waiting for the “perfect.”
The governor’s plan
California Governor Arnold Schwarzenegger has pledged to get his health care reform into law this year. Realistically, to accomplish that goal, the plan will only slightly resemble what he’s proposed. But, even if all he does is move the indigent citizens and illegal aliens out of the hospital emergency rooms by insuring them, that will still mean a sea change in the way health care money is spent in California; and would mean significantly reduced premiums for all of us—without shouldering future generations with a huge additional tax burden. The greatest risk to the plan is that the state legislature and special interests will add so much baggage to it that they’ll kill Arnold’s experiment before it even gets going.
The good news is that new health care proposals from our Democratic legislative leadership are amazingly similar to Schwarzenegger’s proposal. They also aim for universal health care coverage by using the existing public and private programs, making needed change possible by next year. The bad news is, California’s strong liberal powers support State Senator Sheila Kuehl’s government-run, taxpayer-funded, single-payer bill (it passed both houses of the state legislature last year but was vetoed by the governor).
Almost all of the new health care proposals focus on providing benefits to those who are uninsured. Almost all of them predict the costs of health care using various special interest studies, educated guesses, estimates, opinions and other unproven fantasies—all of them seasoned with political dogma of all faiths. Almost everyone, including the American public, wants the finest health care system in the world. What we must decide is how to deliver that health care…and how to pay for it.
Our governor wants to first attack what he calls “the hidden taxes” that currently fund health care for the uninsured. These tariffs include huge hospital and emergency room deficits, high insurance premium costs paid by those with insurance, major health costs incurred because of a lack of preventive care and the expense of medical problems caused by individual lifestyle choices such as smoking, obesity and lack of exercise. With universal coverage, Schwarzenegger believes hospitals, physicians and other health care providers will no longer be forced to treat the uninsured, and so he proposes these providers pay a small percentage of their gross revenue to fund benefits for those now without health coverage. His proposal assumes that California’s mandate to insure everyone can be enforced, and that employers will continue to offer health insurance to workers.
Basic needs
As the debate continues, here are some basic guidelines we should all use to measure the quality of any reforms: First, all Californians should have basic health care coverage that provides the state’s diverse population with equally diverse health care choices. Second, any reform must address and constrain skyrocketing medical care costs, because families, individuals and the state should not be bankrupted or forced into poverty simply to receive (or provide) adequate health care. And finally, all proposed reforms must promote innovation and experimentation so our health care system can continually adapt to the changing needs of our citizens.
To meet these goals, California should require everyone to purchase a basic benefits package, even those who don’t qualify for state programs or subsidies. The state should make insurance premiums tax deductible and require either proof of health insurance coverage or enrollment in a government-sponsored health care program. Unlike mandated automobile insurance, proof of coverage should be confirmed when health care of any kind is accessed. Californians without proof of coverage would be fined and denied state-provided privileges such as a driver’s license or auto registration.
The most critical—and vexing—factor in health care reform is controlling skyrocketing medical costs, which are now the major driving force in rising health insurance premiums. Regardless of how any reform plays out, the cost of health care will ultimately dictate how resources are spent, what costs are born by the insured, what benefits can be provided, what must be omitted, the extent of prescription formularies and so much more. Every day that passes, our population gets older, technologies are perfected and new drugs are conceived; and consumer expectations and values shift and change to reflect this. And a new health care initiative must address these challenges.
California’s health care system works for the vast majority of us, in spite of many problems. But we can do better. Improvement requires strong leadership, thorough public debate of all proposals, tough decisions and difficult compromises. Everyone involved in health care—providers and consumers—will feel some pain as we work to achieve universal gain for all citizens. The status quo can no longer be tolerated.
Californians, and all Americans, must be assured basic health care protection without risking their financial health or the government’s well-being. We must accomplish this goal sooner rather than later, without risking the public’s ability to choose the health coverage that best fits their individual needs. At the same time, we must assure continued access to the services of experienced, knowledgeable, independent and licensed advisers, advocates and counselors.
