24 February 2007

Sen. Sheila Kuehl: patron saint of California healthcare

California State Sen. Sheila Kuehl reintroduced Senate Bill 840 yesterday — that's the same bill with the same number that Gov. Schwarzenegger vetoed last year. This time around it's got 38 authors. There's a rally planned for the steps of the California statehouse on Tuesday. One Care Now, the California organization advocating for the bill, has a page on Tuesday's events.

One Care has a three-minute version of their video explaining single-payer and Sen. Kuehl's bill up on YouTube:

Elsewhere in California, Anthony Wright, executive director of Health Access California, has written a great synopsis of a panel discussion with the Little Hoover Commission — a California state-sponsored group looking at how to make California government more efficient, beginning with healthcare.

Some of the other panelists (Wright himself was one):
• Peter Harbage, senior program associate for the Health Policy Program for the New America Foundation.
• Gerald F. Kominski, Associate Director of the UCLA Center for Health Policy Research
• Glenn Melnick, Professor and Blue Cross of California Chair in Health Care Finance; School of Policy Planning and Development at the University of Southern California

Kominski quoted the Lewin report on what California could expect if the Kuehl bill passed. Initial costs would go up by $25 billion for medical services, but efficiencies (including the use of price controls, reduced fraud, bulk purchasing and $20 billion less spent on private insurance company administration and profit) would save the state $33 billion.
[Commissioner Mitch] Mitchell asked what the minimum basic benefit package should be – and what did panelists think of the $5,000 deductible minimum plan the governor proposed, for those who would not qualify for subsidized coverage.

Kominski laid it out. Such a plan would cost a family about $200 a month -- $5,000 a year.[?] On top of that, the families would still have to pay $5,000 deductible. That’s $10,000 before they even see a dime of coverage. “If these policies were so desirable, why don’t we all have them?’’ he asked.

I said such policies caused families to have to “pay to be uninsured," paying premiums but still facing worse health outcomes and the possibility of medical debt and financial ruin. The other danger of high-deductible plans, he said, is cost-conscious consumers would have to decide which procedures were “necessary’’ and which were not. Half the time, they guessed wrong and forgo preventive treatments that end up making them sicker and costing more money to treat. Some may not also have the cash necessary to pay up front for doctor’s visits.

Mitchell asked why it would not be sufficient to have a high-deductible plan that also covered preventive services. While some high-deductible plans do allow for preventive services, they’re limited, I said. And if a consumer has a chronic disease, such as diabetes, asthma, heart disease, which require regular doctors visits and medications, such a plan would not work for them. Chronic diseases are also the largest cost drivers in health care, and to exclude such coverage would just make matters worse, experts said.
I read this and also Wright's group's blog on the commission, and they sure sound similar to the 208 commission in Colorado.

They're a bunch of bright people doing their best to get around the fact that the solution to the healthcare crisis is blindingly obvious yet somehow off limits.

Actually, maybe the California commissioners aren't all that bright. Commissioner Daniel Hancock suggested that Medi-Cal patients be “timed out" of their entitlement benefits — as welfare recipients were put on a five-year lifetime limit during the 1996 welfare reform.

Now there's a plan. Just because millions of Medi-Cal enrollees are seniors or people with disabilities – on respirators, wheelchairs — doesn't mean they can't get work. Let them join the rest of the working poor. Wheelchair-bound or not, they could all pay $11,000 plus annually for health insurance if they stopped squandering their money. The back of a Buick is a fine place to raise a family — or come home to in those golden years after a hard day's work at Burger King.

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