Pursue Health Reform Carefully, Not in a Rush
In light of recent polls indicating many Californians
are dissatisfied with the health care system, it should come as no
surprise that it’s an issue under much scrutiny. Now that the
Governor has called a special session to focus on this area, the
state legislature will have an opportunity to address this issue
directly. Virtually everyone agrees that some kind of health care
reform is necessary, but, as with much that government attempts to
do, the devil is in the details.
The Democrats’ proposals range from Senator Kuehl’s
full-fledged single-payer plan to variations of universal health
care that burden employers and hospitals with onerous new taxes or –
wink, wink – “fees.” The Governor has vowed to veto Kuehl’s SB 840,
but other proposals, such as Speaker Nunez’s AB 8 still threaten
small businesses with the burden of higher taxes.
More to the point, AB 8 offers no remedy for the core
problems vexing the state’s health care system. It throws a lot of
money – someone else’s, naturally – at the issue without reducing
costs or improving the quality of care or access to it. The
Governor’s plan isn’t much better, requiring every business with ten
or more employees to provide health benefits while taxing hospital
and physicians’ revenue.
Senate Republicans introduced our own comprehensive
health care plan earlier this year. Contrary to the Governor’s
assertion, echoed by legislative Democrats and some in the media, we
were actually quite eager to be included in the debate.
However, Speaker Nunez’s statement that health reform
“really comes down to three people, let's be honest,” belies the
assertion that Republican Senators had any power over whether health
care was tackled this year or not. So to does the fact that
Democrats long ago secured an unusual Legislative Counsel opinion
determining that the fees AB 8 would impose are not taxes and, thus,
are not subject to the two-thirds requirement that would make any
Republican support necessary for its passage.
Meanwhile, our plan, dubbed CalCare, languished in a
committee all year without so much as the courtesy of a hearing,
which is a shame because it actually would address some of the
issues driving cost increases in the present system.
In addition to providing inducements for hospitals
and private industry to create new clinics, Senate Republicans
sought to adjust physician oversight requirements in order to allow
registered nurses and other highly qualified health providers to run
primary care clinics. By increasing the availability of such health
care facilities, particularly in rural and underserved areas,
California could provide a more convenient and less expensive
alternative to overused emergency rooms.
CalCare also advocated conforming California’s tax
laws to federal guidelines governing Health Savings Accounts. Health
Savings Accounts are modeled after Individual Retirement Accounts,
allowing people to put aside savings, tax free, for future
out-of-pocket medical expenses. While these savings are not taxed by
the federal government, they are taxed in California, creating a
disincentive to use such funds and a bookkeeping headache if they
are. Senate Republicans also recommended regulatory changes allowing
insurers to offer more flexible health care plans, in order to give
consumers greater options in the coverage they actually need.
Unfortunately, neither Democrats nor the Governor have paid these
modest reforms much heed. Instead of taking a realistic step forward
and establishing some common ground to build upon next year, they
appear determined to rush radical action through at the last minute.
Ten years ago, the legislature passed an
eleventh-hour bid to deregulate electricity, which while
well-intended, ended up contributing to the energy crisis that
nearly crippled California. The lesson we should have learned then
is that hastily action does not equal sound reform.
Of course, health care policy is not as arcane as the
ins and outs of energy markets. It’s about people and their quality
of life – all the more reason to pursue reform thoughtfully and
concluded budget stalemate undoubtedly left everyone in Sacramento a
little bruised and worse for wear. Some believe a comprehensive health
care reform package would certainly help the Governor and some
legislative leaders save face. It would be a terrible mistake,
however, to push a flawed and half-baked proposal on the people of
California just to say something – anything – was done.
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