In response to Matthew’s take on California Governor Arnold Schwarzenegger’s Massachusett’s-style plan to require that all state residents purchase insurance ("California Not Really Uber Alles" 12/26 ) contributor and friend of THCB Jeff Goldsmith writes:
"Isn’t it interesting that the projected California budget deficit
and the cost of the health reform program are both about $14 billion.
So to fix both of them would thus requires the state to find a mere $28
billion? That’s the real reason it isn’t going to happen, not provider
lobbying or employer intransigence. No state can really do something
like this by itself without wrecking its economy. It is what we have a
national government for.
It isn’t really that hard conceptually to construct an affordable
benefit. Remember the large majority of the uninsured are young people.
A stripped down package which covered primary care MD services, dental
care, chronic care type drugs like insulin, and catastrophic
hospitalization coverage (w/ some type of negotiated deep discount for
the patient’s part of the hospital bill) would do the trick.
The problem is stopping one’s ears for all the sob stories from the
chiropractors, podiatrists, aromatherapists, etc. who want to force you
to insure for their services. Your suggestion that the real problem is
retaining employer based coverage still dodges the question that
somehow, somewhere, a legislative body still has to define what
coverage is mandated.
Why do you think employers are so resistant (a 7.5% payroll tax
might be part of the explanation)? It is because thirty years of
legislative history suggests our elected representatives, like that
easy woman in the musical Oklahoma, "cain’t say no". Mandated in vitro
fertilization, breast reconstruction after cancer surgery, etc. – all
worthy goals in a resource unlimited world, but death to an affordable
Oregon’s John Kitzhaber, an emergency physician by training, seems,
so far, to have been the only political leader of either party to have
figured out that making these types of hard choices is the real problem
in health reform- not "play or pay", tax deductions or hard subsidies,
employer or individual mandate, or all the other comparatively trivial
choices. Listen to all the pervarication from the Presidential
candidate poseurs on what actually gets covered. It’s enough to turn
you into a New Zealander."
EDITOR’S NOTE: Jeff Goldsmith is the president of Health Futures Inc. From 1982 to 1994, Jeff served as National Advisor for Healthcare
at Ernst & Young. From 1980 to 1990 he was a lecturer at the
Graduate School of Business at the University of Chicago. He currently
serves on the editorial board of Health Affairs. His past pieces for THCB have included "The Perpetual Healthcare Crisis" and "Employers’ Health Cost Growth Continues to Moderate: Ain’t It Awful?"