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Health Reform and the Year of Magical Thinking

By Senator Sheila James Kuehl

The Year of Magical Thinking is the title of a memoir by Joan Didion detailing her state of denial, inexplicable behaviors and, finally, coming to grips with, the death of her husband. It’s also an apt description of the Governor’s 2007 approach to reforming our broken healthcare system, with the glaring difference that he still hasn’t come to grips with the truth. (After all, if a complicated movie plot could be resolved in less than two hours, why not fix healthcare in California in nine months?)

Beginning in January, the Governor ordered his health advisors to sketch the outlines of a plan that would magically “cover” all Californians by simply requiring them to buy health insurance. To this moment, he has refused to negotiate any of his major points with the Legislature. The language for his plan was finally drafted five months later, and shown, under wraps, to a few, select people. Not one legislator agreed with it, and no one would carry the bill as legislation.

To fill the void raised by the Governor’s magical “we must do something this year” drumbeat, the Democratic leaders began crafting their own reform plan. To date, however, the Governor and the Legislative leadership have remained oceans apart on the broad policy strokes of health care while public support for the current insurance-company controlled system has plummeted and support for the reforms contained in SB 840, the Medicare-like fix for California, has grown.

Now, with less than two weeks remaining in the first half of the two-year legislative session, there is still no “something” on the table and the Governor, like a Barnum and Bailey’s ring leader, continues to announce that he will, assuredly, pull a rabbit out of a black hat. Actually, there is no way of knowing if the result would really be a rabbit; it could just as easily be an albatross.

The Governor has further limited discussion by announcing that he would veto both of the legislative proposals that have actually been introduced as real bills. SB 840, by far the most carefully crafted, transparent and fully vetted bill, will remain in the Legislature until next year, since sending it down to him for a veto would end any consideration of single payer until 2009.

The individual mandate provisions in the Governor’s pronouncement are being emphatically rejected by virtually all stakeholders representing the people who would be forced to pay uncapped premiums. The percentages to be paid by employers and individuals, hospitals and doctors, people in a “pool” and those outside, those above differing percentages of the poverty scale and those below, are so far apart in the Governor’s pronouncements and the Speaker’s bill, you could drive trucks through the gaps.

The Governor’s lynchpin financial mechanism of a provider tax remains submerged under the very murky water of a 2/3 vote. What convoluted compromise might be devised in a last-minute attempt is anyone’s guess.

Nonetheless, we are told that, unless we agree to pass a yet-to-be hastily drafted bill that incidentally may be the biggest reform proposal ever attempted in health care, and pass it in two weeks, thus completely bypassing the entire political process and any semblance of open public input, we’ve completely failed and health reform is doomed forever. Please.

The prospect of legislative staff, sitting behind closed doors, hastily crafting a 100-page health reform “compromise”, to be pushed through the legislature with little or no public input over the course of the next 14 days, is deeply irresponsible. Frankly, given the example of the energy deregulation bill, we ought to know better.

Moreover, we lose nothing by taking advantage of the fact that the sessions of the California legislature are two year sessions. Many of our major accomplishments, most recently, AB 32, the bill related to greenhouse gas, took more than one year to achieve.

Next year’s Presidential campaigns will ensure that health reform stays as the top of the agenda. More importantly, the issue of health reform will continue to dominate because the people need it and want it. What they want, and deserve, however, is responsible health reform, not a new debacle that benefits the health insurance companies the way the electricity bill benefited Enron.

Finally, we must not forget the reason that we are in this crisis to begin with. Health care premiums changed by insurance companies continue to grow 3-4 times faster than wages. A solution is needed that pays attention to adequate funding, affordability, cost controls and quality.

Even if the Legislature should pass a last minute convoluted experiment in health reform, there will still be a need to continue the work to enact a fully vetted, Medicare-like single payer system that replaces the insurance companies with a plan for all Californians, allows each person to choose their own providers, and protects affordability, comprehensive coverage and quality. Such a solution is the only sensible and tested way to achieve universal health care responsibly.

Whatever happens in the next two weeks, the movement for single payer universal health care is continuing to grow, and SB 840 will continue as its focal point, the only legislation that establishes the kind of truly universal, modern and affordable health care system the people of California need and deserve.

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