So after being peppered with criticism from both term limits groups and the California Nurses Association, the Speaker's office has chosen which group to strike back at: the nurses, of course, using the exact same standard of judgment that they called a "smear job" when it was used against Nuñez.
This is an argument over improving the delivery and cost of health care, and there's plenty of ideological rigidity to go around. What started as a promising "year of health care reform" has devolved into putative allies arguing about how much money the other spends on hotel rooms. Behind the mere gaining of political points is a serious debate about how to best allow all California citizens, not just the ones with full-time employment (us freelancers need health care too), the highest quality affordable health care they can manage. And the real truth of the matter, the one that nobody really wants to talk about, is that none of these state-based plans, by definition, have any hope of working and have serious potential consequences, besides. I think that's why everyone's getting so mad at one another, because it's easier to do so than to face the facts.
We've got all these great universal bills passing at the state level, and I'm here to tell you that, well, they are pretty great, but they're not going to work. It didn't work in Washington State, when they tried it, and the insurers first jacked up the premiums, and then moved out of the state in order to kill the model. It didn't work in Hawaii, which saw an economic downturn move more people onto their subsidies exactly as the state's revenues dropped. It didn't work in Tennessee, where the Democratic governor, Phil Bredesen, upon killing off Tenncare and leaving 300,000 people uninsured, told his state that, "I say to you with a clear heart that I've tried everything. There is no big lump of federal money that will make the problem go away." Similar plans failed in Oregon, in Massachusetts, and many other states.
The plans fall for a few small reasons, and one big one. The big one is that states don't have the fiscal stability to run universal health care. 49 of 50 states cant deficit spend. That means that when the state goes into recession and more people need subsidies and the revenues to give them don't exist the state can't borrow the money. So they dismantle the program. It's happened time and time again -- in some states, like Oregon, more than once.
Moreover, you don't really want this being a state-run solution. As a stopgap, increasing coverage through state plans is worthwhile, but health care reform is more than access - it's actual reform to bring down costs, which are, at the end of the day, the biggest problem in the system. And the states don't have the regulatory authority, the money, or, save in a few cases, the size to do that. I simply don't trust them to fundamentally reform the system.
California is obviously one state that has the size, and certainly could float ever more bonds to spend the necessary money. But we're almost certainly on the cusp of a new recession, and the combination of massive debt passed on to grandkids and a pay-to-play system that still reigns supreme in Sacramento is unpalatable to reform.
I repsect the efforts of groups like Physicians for a Naitonal Health Plan, who have studied the issue and recommended some of the best possible solutions. But that word "national" is hard to get around; it's the only way to create the real economies of scale and managed risk necessary for a solution. I believe in health care for everyone, not simply in red states or blue states. As Ezra Klein notes,
You know, whenever you talk about the state reforms, you always hear the old Brandeis quote about the "laboratories of democracy." But there's another Brandeis saying that I think is more applicable: "If we would guide by the light of reason," he said, "we must let our minds be bold." And that's what I'm asking: Be bold. Because nothing else will, in the long term, work.
I've been watching the debate in the Congress over expanding S-CHIP (the State Children's Health Insurance Program) today while waiting for my plane travel to Yearly Kos, and I'm reminded of how dishonest Republicans are on this issue. They created the block grant program to give states the ability to cover children, and now when it's become popular and successful, and state governors want to expand it more, they suddenly want to stop it. And they're using the familiar "this would let illegal immigrants get free health care" canard to try and submarine the bill (incidentally, it doesn't).
It's important to chronicle this, because it's the opening salvo in the battle to change the health care system in this country. In California we're gearing up for health care reform, and today The California Budget Project and the UCLA Center for Health Policy Research released a joint report that ably shows the consequences of maintaining the broken status quo on health care as the Republicans want to do:
The public hearing scheduled for July 19 about Blue Cross of CA and its deceptive, anti-consumer practices will now be held on August 7. Not only are they angering their subscriber base by going out of their way to deny claims and cancel policies for "discrepancies" as trivial as typos, but they're starting to piss off hospitals as well.
Blue Cross of California's latest antidote to rising healthcare costs isn't going down very well with physicians. The state's largest for-profit health plan is set to roll back its payments for about half the services and procedures provided by physicians next month.
And many of the 53,408 physicians in Blue Cross' preferred provider organization (PPO) networks say that's a prescription for disaster.
Doctors say the health plan imposed the new rates unilaterally. In most cases, they say, Blue Cross will get its way because it controls the lion's share of their patient base. But other physicians say they've had it with Blue Cross. More than 300 of them have sent notices threatening to dump the insurer if the rates take effect as scheduled Aug. 6. Some say the new rates won't even cover the cost of supplies. 'I don't know how anybody can afford to stay in practice and accept Blue Cross rates,' said Dr. Charles Fishman, a San Luis Obispo dermatologist who sent a letter telling Blue Cross he would drop its contract if his rates were not improved. A spokeswoman for the insurer described the level of complaints over the new rates as routine, and she said the number of termination notices from physicians over the issue was negligible - less than 1% of the doctors in its PPO networks.
Surely, this will come up in the August 7 hearing, to be held at the Carmel Room Auditorium at the Junipero Serra Building, 320 West 4th St., Los Angeles, from 10 a.m. until 3 p.m. And It's Our Healthcare is amping up the pressure by demanding that Blue Cross return to the state millions in excess profits:
(I added the video of the Perata/Nunez presser after the flip - promoted by Brian Leubitz)
So, as expected, the leadership in the state legislature has agreed to combine their bills on health care reform. The significant number is that the bill would require businesses to spent a minimum of 7.5% of payroll on health care. But this newest proposal doesn't come close to being universal.
Most significantly, they agreed to drop the Senate plan to require that Californians with more than modest incomes get insurance. That was intended to be the middle ground between Schwarzenegger's insistence on universal coverage and the Assembly's rejection of any requirement that people have insurance.
Senate President Pro Tem Don Perata (D-Oakland) and Assembly Speaker Fabian Nunez (D-Los Angeles) also agreed to apply the business requirement to every enterprise except the self-employed. The Assembly plan had carved out large exemptions for businesses with only one employee, those with payrolls of less than $100,000 and those that had been in operation for three or fewer years.
The Governor held a press conference today as well, and pretty much said that you need an individual mandate, and that nothing the Legislature passes matters, that he'll work it all out in secret. Now THAT'S transparency in government!
I do think that somewhere down the line, an individual mandate does make some sense because it spreads the risk pool. And I think this new bill strengthens the tying of health care to employment, when that really should be severed. But putting in an individual mandate without regulating the insurance companies to any major degree, or setting any ceiling on affordability or floor on coverage, seems like nothing more than shoveling billions of dollars to the for-profit healthcare industry. So I'm not particularly jazzed by any of these proposals outside of SB 840, which of course will be vetoed. The Perata/Nunez plan looks to me to be insufficient, though I'll wait for the release of details.
The fact that Blue Cross of California is leading the insurance company effort to stop any reform in the state's health care system makes me smile broadly. There couldn't be a more reviled corporate entity around these parts than Blue Cross, the team who systematically tried to throw any sick person off their rolls and reduce any effort to get them to actually pay for medical treatment, which after all is their entire job. Health Access picked up on this and noticed that Blue Cross tried to use the Enron energy crisis as a scare tactic ("Unintended consequences do happen"), when in fact nobody is more like Enron than... Blue Cross.
Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.
BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.
I don't think it's may, I think it's will.
Nobody's going to buy this for a second. That's why the campaign is only in Sacramento and not statewide. If our leaders in this state are anything like Democratic national leaders, they'll immediately drop all health care reform plans for fear that Blue Cross will continue to be mean to them. But having Blue Cross argue about responsible health care policy is like having Tony Soprano argue about gun control. And it's up to us constituents to let the politicians know that. If Blue Cross is the face of health care status quo, I'd say change is a-comin'.
Elizabeth Edwards' acknowledgement of the recurrence of her breast cancer (which I hope is not more serious than the Edwardses made it out to be, but which I fear is) was but one story of cancer attacking prominent political figures. Tony Snow will have surgery for a small growth under his abdomen; he had colon cancer two years ago, so we hope that it's nothing more serious. And most tragically, conservative commentator and blogger Catherine Siepp succumbed to lung cancer. Cancer is not a disease that picks between political affiliations for who it afflicts, that much is clear. And so a problem affecting everyone must be solved with a universal solution.
Before she died, Catherine Siepp wrote about her experiences with Blue Cross of California. It was a bit shocking to hear a committed conservative talking about the failures of our health care system in such a frank and direct manner, but when a health insurance conglomerate acts so dishonestly, anyone in that position would be offended regardless of their politics.
