| The first problem: there is not nearly enough cost control. Under the proposal, almost all Californians would have to buy health insurance - but there are not sufficient guarantees that the insurance polices are going to be affordable. There will be direct subsidies for families making up to 2.5 times the federal poverty level, or $51,625 for a family of four. There will be tax breaks and a buying pool for families making between 2.5 times the poverty level and four times the poverty level, which is $82,600 for a family of four. But here in San Francisco, and in most California cities, a family of four making $83,000 is hardly wealthy. To require these families to buy a product without sufficient guarantees that this product is affordable is not sound policy.
Another unacceptable risk: not enough protections against "dumping." This plan needs real barriers to prevent big companies that hire low-wage workers (like WalMart) from merely pushing the healthcare burden onto taxpayers.
Yet another flaw: the plan is unclear about how it will provide sufficient coverage to undocumented workers. How can we even be talking about a "universal" plan that could leave out millions of people? The plan needs to create a way to cover everyone working in California regardless of immigration status - perhaps with more support for the county health systems that are now the healthcare providers of last resort.
It is certainly true that expanding the pool of people with health insurance will create savings. And making sure most Californians have preventative care is both a giant step forward and a significant cost control. But even these two important improvements are still not enough. We are still going to be burdened with a system that wastes billions of dollars on unnecessary overhead and bureaucracy.
And that's the important and unanswered question with this proposal - does this plan get us closer to a sensible Single Payer system or does it take us farther away?
We are now implementing a universal healthcare system in San Francisco that achieves affordable and quality care largely by expanding our network of public hospitals and clinics. This care is affordable because the city itself acts in most cases as the "Single Payer." We don't waste up to 33% in insurance company overhead because there is no insurance company. And profits that would go to insurance companies can be invested in better care.
This kind of direct access to care and a Single Payer system is a model that will work in California and ultimately the rest of the nation.
I, for one, am not opposed to interim steps on our way to Single Payer. We all need to understand that building a workable Single Payer system will take time. But I want us to keep moving in the right direction. There is a compelling argument that the purchasing pool created under this proposal will be a first step toward Single Payer.
If correct, that's a strong argument in favor of the plan. But I'm not convinced that this plan, as currently drafted, is moving us toward our ultimate goal of affordable and quality care for everyone. |
