In the world of health reform wonks – the writers on this blog qualify in spades – all eyes
are on California at
the moment. His Republicanism notwithstanding,
Governor Schwartzenegger has developed a generous $14 billion bill that
would extend universal coverage to all Californians by 2010.
that the plan is set, the special interests are lining up. Most of the
health care groups – the physicians, hospitals, the health plans (with
the interesting exception of Wellpoint) – are supportive, fully aware
that if more money can be found for health care, they’ll be the
recipients. Also in the mix are two prominent unions: SEIU (the Service
Workers’ International Union) and the American Federation of State,
County and Municipal Employees. They are both key supporters, each with
health care workers who would benefit from the deal.
Now it comes out
in the LA Times that the Governor’s ally in the reform package,
Assembly Speaker Fabian Nuñez, sweetened the deal for these unions’s
members with millions of dollars in workers’ training and benefits. Here at The Health Care Blog, SEIU Executive Vice
President Mary Kay Henry, posted a piece called "As Goes California, So Should The Nation," hawking the reform proposal, but conveniently leaving out that SEIU’s members will get special benefits in the deal.
got calls from several reporters yesterday asking about the prospects
for real reform in California. Alas, as much as I would like to see it,
it seems very unlikely. California’s reform proposal is all about
universal coverage, and almost – not quite, but almost – absent
meaningful cost controls. It finds new money from purchasers to pay for
the care, but extracts virtually no concessions from the health care
sector on how that care will be supplied or delivered. It will remain
impossibly expensive. A couple making $54,000/year – more than the
subsidized 400% of poverty – will be required to come up with $12,000
for health care, or more than 1/5 of their income. Pretty onerous.
of this is lost, of course, on the business sector, which has not yet
begun to flex its influential muscles. Assuming that the reform
proposal is pushed out to a referendum, it will become a battle of the
propogandists. My bet is on the businesses who comprise 6/7 of the
California economy, and who will feel that the cost is too lopsided and
too excessive, that too little has been asked of the health care sector
and that no disciplines have been demanded.
The jury’s still out,
but I can’t believe that meaningful reform will win out in California.
Because, in the end, the ways that it is playing out is unchanged from
the core of the problem itself. There is little consideration of how
best to provide health care, but who will win the biggest purse. And
that approach never really solves problems.