The Senate Health Committee held its first hearing on SB810 (Leno), the single-payer health bill. While I've made my belief in the inevitable problems of states trying to fund health care when they cannot deficit spend well-known, if I was on that committee I'd go ahead and vote for it. But I recognize the need to strengthen the broken health care system on all fronts, given the political realities that the Governor has vetoed single-payer multiple times in the past, and that the Republicans will never sign off on the funding, and so even if by some miracle the Governor put pen to paper we would have to wait until 2010 for full passage, and another year for implementation. In the interim, a number of very interesting health care reforms have cleared the Assembly Health Committee already, and progressives should take notice of them. Anthony Wright has some of the details.
The Assembly Health Committee on Tuesday approved a number of key health consumer protections. The measures would expand guarantees of coverage to Californians who are underinsured, uninsured or, in some cases, just plain inadequately served by their health care providers.
One of the bills would sharply increase civil fines in response to the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. Another would address a vast, and quickly expanding, demographic of the uninsured--young adults transitioning between school and careers that offer financial stability and benefits.
Yet another would require insurance brokers and employees to reveal their financial interests-such as paid commissions - in selling certain health care policies. One measure would require private providers to cover more of the costs of doctor-ordered medical equipment, something Medicaid and MediCal already do.
See the post for the full details on AB1521 (insurers revealing their commissions), AB730 (big fines for rescissions), AB29 (raising the age limit for dependent coverage from 19 to 26) and AB214 (requiring health plans to cover durable medical equipment). All 4 would have an immediate and tangible benefit for Californians, and all are common-sense reforms. Fining rescissions would attack the inequities in the system and prevent fraud, as would the agent commission rule. Raising the age limit would provide stability for those young people transitioning from college to starting a career, and adding protections for what is insured also adds stability (the fact that people can be made to pay for their own wheelchair is kind of nuts). None of these deal with the long-term cost drivers that bust state and federal budgets, and none deal comprehensively with the crisis of the uninsured. But all of them help, and we need to press forward on all fronts right now.
Hundreds of people, nurses, doctors, medical students, grassroots activists, and California School Employees Association members gathered in downtown Los Angeles Monday to deliver an unequivocal message about the nature of the healthcare reform Americans so desperately need.
For those inside the tightly scripted White House Forum or anyone watching the live feed on line, that message was blacked out. Inside the pre-selected speakers kept within the accepted framework: we need reform, costs are out of control, Americans are hurting, and preventive care will solve all our problems ('fraid not). Unfortunately nothing proposed in the forum is likely to cure this crisis.
With the final White House Forum on healthcare scheduled Monday, April 6 in downtown Los Angeles, advocates of single payer/guaranteed healthcare have one more opportunity to shake up what has become a dreary conventional wisdom about the presumed acceptable parameters of the debate.
Hundreds of nurses, doctors, healthcare and labor activists will rally at 9 a.m. outside the California Endowment, 1000 North Alameda St., Los Angeles.
It will mark the fifth time, at all five White House regional forums, that the single payer/Medicare for all message will come to the stage, outside and inside the forum. You can extend that to the town hall meeting at the White House last week where the President was asked why we can't have a national healthcare system like they have in other industrialized nations.
Lots of people are showing up at the White House forums on healthcare and delivering a very different message from Beltway insiders about what the final bill should look like.
In Des Moines Monday, registered nurses, doctors, and other healthcare activists, led by the California Nurses Association National Nurses Organizing Committee, Minnesota Nurses Association, Physicians for a National Health Program, and Healthcare Now, showed up outside the hall pressing the case for single-payer reform, and then took the theme inside the meeting.
Single-payer healthcare reform has a new bill number and a new sponsor. With my former State Senator Sheila Kuehl termed out, Mark Leno has stepped up to carry SB810, which in the past was known as SB840. The bill would, in the words of the press release, "guarantee comprehensive health care benefits to every California resident and streamline claims and reimbursements, which will save billions of dollars in health care administrative costs." Here's Sen. Leno:
"As a nation, we spend twice as much per person on health care as other wealthy countries, with the hope that our families will be protected from illnesses, yet most insured Americans still worry about how they will afford critical care if they become sick," said Senator Leno. "In California, 7 million people do not have health insurance. Wasteful health care spending is crushing our economy and forcing families to forego basic medical care. With the money we spend today on health care, California can have a modern, universal health care system that provides high quality care for everyone," he said.
A version of this bill has basically already passed the California Legislature, only to be vetoed by the Governor. So it shouldn't be a surprise that 43 lawmakers, including both leaders in the Assembly and Senate, have already signed on as co-sponsors.
Given the conservative veto and the 2/3 rule for revenue, SB810 lacks a funding source, so even if it were signed at some point - and realistically, Governor Schwarzenegger won't be the one to sign it - supporters wold have to go to the ballot to raise the necessary revenue to fund the bill.
There is no question that our health care delivery system is grossly inefficient, and insurance company profit and overhead is a pool of money that does little to provide quality care. As a nation we spend an extreme amount on health care - $2.4 trillion dollars in 2008, closing in on 20% of GDP - without a proportional increase in health care outcomes over the rest of the industrialized world. In fact, we pay more for care while ranking below dozens of nations in quality. Single-payer care, while varied in different nations across the world, has generally been proven to offer the best quality at the most reduced cost.
But of course, that is on a national level. And even though with 38 million people we have as many citizens as several other nations which have implemented single-payer, universal health care, what we lack is a printing press to coin our own money. Given the constraints of a balanced budget, given the far more onerous constraints of the conservative veto, and given that states have little control over the boom and bust cycles of the national economy, universal health plans have largely come ashore and beached when they are done at the state level. There are certainly reforms that can take place here, but we need the structural reform to set the table for them, and even with that, I am highly dubious (though willing to be convinced) that any state can manage UHC on their own without the tool of deficit spending that would occasionally be needed. And history bears this out.
In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table." -- President Obama, opening the White House health care summit.
Except one idea, apparently. The one reform that will actually contain health care costs, cited by the President as his main goal, and, as a bonus, solve the healthcare crisis -- single payer, or expanding and upgrading Medicare to cover everyone.
In the weeks leading up to the summit, the White House made sure all the people it wanted in the room were there. The insurers, drug companies, corporate lobbyists, and those consumer and advocacy groups willing to play by the script.
One segment, however, was conspicuously absent, advocates of single payer reform. Who happen to include, nurses and doctors, the people who have the most daily experience with the collapsing health care system and who by large margins support single payer.
(Not totally a local issue, but it involves a lot of local players, and continues on a subject that gets a lot of attention around here, so I thought I'd share. Reprinted from my site.)
There's something of a consensus that Netroots Nation didn't offer enough adversarial panels and instead largely consisted of bloggers agreeing with one another. But that's not true. I personally witnessed the most adversarial panel of the weekend, and it was spectacular, because finally, both factions of the debate about health care policy on the left were able to come together and understand the political contours of the brewing fight in the Congress.
Dan Weintraub has a stupid column about single-payer health care that uses the same rhetoric that has locked us into a broken status quo for the history of the Republic. He claims that a new legislative analyst's report of the costs of SB840, if implemented today, would leave the state $40 billion dollars in the red after just one year. That's true, but as Sheila Kuehl explains, that's because health care costs have soared while wages remain stagnant, and thus the numbers from the original assessment of the bill are completely out of date. Weintraub then achnowledges this, but asserts that only 50 percent of the deficit can be attributed to a run-up in health care costs.
Of course, that's $20 billion dollars. And one element that Weintraub refuses to consider is cost control, which is the only way any fundamentally new health care system will survive, be it single payer or a collective-responsibility plan like that rejected by the State Senate last year. Weintraub never tries to factor in cost control. He never manages to analyze whether or not a system that takes middle men out of the process and removes the profit driver might be able to reduce the price of quality care. In the same way he never considers whether mandating that insurance companies spend a high percentage of premium revenue on treatment and care would reduce those costs he sees as fixed.
Spending on health care is out of control because there is a patchwork quilt of delivery services, diced up between insurers, hospitals, managed-care organizations, and other elements who add cost without impacting quality. It's, in short, an efficiency problem; the United States is grossly inefficient in its delivery of services, and despite superior technology and high spending has a life expectancy which trails 30 other countries and has the highest rate of underweight babies in 40 years, to cite just two examples. Subjecting a fiscal analysis of a system that would eliminate or sharply reduce the fiscal burden of this quilt to the old rules, and the old costs, makes no sense whatsoever. It's like doing an fiscal analysis in the 21st century of the naval budget, factoring in the effects of ships falling off edge of the world.
There's also the moral argument that we have over seventy million uninsured and underinsured Americans in a country which lists "life" as a fundamental inalienable right. But I'll shove that aside for a moment to deride Weintraub's limiting analysis.
AHIP, America's Health Insurance Plans, decided downtown San Francisco would be a good place for the health insurance company lobbyists and executives to hold their convention. Not surprisingly, thousands of people will take to the streets at noon on June 19th at the Moscone center to protest getting ripped off by the health insurance companies and rally for SB 840 in California and HR 676 nationally.
One of the key people being protested is none other than former DNC Chair Terry McAuliffe who is a keynote speaker for the industry. Which adds some context to his quotes in yesterday's New York Times on the Clintons' enemies list and rewarding of friends:
"The Clintons get hundreds of requests for favors every week," said Terry McAuliffe, the chairman of Mrs. Clinton's presidential campaign. "Clearly, the people you're going to do stuff for in the future are the people who have been there for you."
Finally, we've recovered from McAuliffe's disaster as DNC Chair when he ran it like the DLC and was proven incapable of moving beyond transactional politics to a post-McCain/Feingold fundraising party that isn't a subsidiary of special interests. And yes, we've also moved beyond his success in perfectly executing a Clinton campaign strategy that took her from undisputed presidential front-runner to junior senator. But there is he is, using his name and connections to help out those who have helped them while Americans suffer.
In my opinion, one of the most important outcomes of Clinton's loss was that they won't get back control of the DNC -- which is great news for Democrats. But T-Mac is a reminder that we all need due diligence in the process of choosing the next California Democratic Party Chair so that we can reform the CDP to also move into the 21st century.
Currently, there are 1,904 pledged attendees at the rally according to the neat online organizing tool. Check to see which groups have currently pledged how many, get your group involved, and join in this important event.
I'll let folks draw their own conclusions and pick their own fights for the most part, but I thought this poll (link changed to pdf of Field Poll) was pretty interesting (favorable/unfavorable/net):
California Nurses Association/Nurses: 53/15/+35
California Hospital Assn./Hospitals: 33/30/+3
Gov. Arnold Schwarzenegger: 40/40/0
Assembly Speaker Fabian Nunez: 20/29/-8
Chamber of Commerce/Business Groups: 25/36/-11
News Media: 28/46/-18%
Republican State Legislative Leaders: 22/48/-26
Health Insurance Companies: 16/55/-39
I will throw a few rather obvious ones out along with one that may be less so. One- people don't care much for politicians. Two- they care even less for the media, which is interesting as the media keeps cutting back on news coverage. Three- they HATE insurance companies, which makes me wonder why anyone keeps trying to keep them in the equation.
Also, CNA's numbers are pretty darn impressive. Some of that is that people just like nurses I would imagine. But average Californian on the street, if they have an actual opinion of CNA proper, it's likely to be an opinion on single-payer. Which makes me think that, given the opportunity, people might be pretty supportive of single-payer.
With the collapse of the Schwarzenegger/Nuñez health care plan, the obvious inequities in a broken system continue. And legislators who have the motive, means, and opportunity to do what they can to reverse that have an obligation. Here's what I wrote in Speaker Nuñez' diary on the day of the Senate Health Committee vote:
...for whatever reason, your compromise isn't going to pass today. Now do you stamp your feet and wag a finger at those who submarined it and sit in the corner, or do you work to enact something that would be meaningful to California's many uninsured. That's the position of the moment, and so don't tell us why others have messed up your deal, tell us what you're going to do right now to pick up the pieces and move on.
Núñez suggested that support for a government-run, "single-payer" system lurked in the background and wound up undermining AB X1 1.
Schwarzenegger vetoed a government-run proposal in 2006. Another single-payer measure, Senate Bill 840 by Sen. Sheila Kuehl, D-Santa Monica, is pending in the Assembly.
Núñez vowed to subject it to the same kind of scrutiny his now-dead plan received. "I think it's time," he said, "for us to have an honest conversation about single payer."
He said that lawmakers "cannot create the false sense of hope that we can do something better if it hasn't been tested and put through the same type of scrutiny that our effort was put through."
What good is this "You drank my milkshake, now I drink your milkshake!" strategy? Is it really worth it to 6.5 million uninsured Californians to react to the demise of one health care plan by bulldozing another health care plan? This solipsism, the lashing out, the power plays, is exactly what's wrong with Sacramento.
The lessons of 1994 are that a combination of bad timing and the lack of openness in the process is what killed the Clinton health care plan. That's exactly what derailed this plan, and the proper response is to fix the eternal budgeting problems that will always make an overhaul supremely difficult, and to build a coalition that includes the grassroots in a deliberative way. The opportunity is going to be there if the budgeting structure is righted. But the CDP would need to get behind it on the ground. The groups that do appear, and let me stress that word, appear to be holding out for single payer, need to be brought into the process rather than assailed. There are national allies like MoveOn and the Campaign for America's Future and the whole of the progressive movement that could be invited into the process. And there are small-bore reforms that we could enact right now, that would prepare the ground very well for a national program like Ron Wyden's Healthy Americans Act or the proposals of the Democratic candidates, which have a much more stable federal fiscal structure on which to balance.
Too much of this process has been focused on tearing each other apart, and it's very upsetting to see the leadership continuing down that path.
We need organizations who aren't afraid of what is politically possible and talk about was is morally right. Today the CNA placed a full-page ad in 10 Iowa papers arguing strongly for not-for-profit health care, Medicare for All, taking the example of Dick Cheney's multiple heart problems, and noting that if he wasn't receiving the finest in government-run health care, he'd be dead by now.
The patient's history and prognosis were grim: four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator and now an emergency procedure to treat an irregular heartbeat. For millions of Americans, this might be a death sentence. For the vice president, it was just another medical treatment. And it cost him very little.
Unlike the average American, the president, vice president and members of Congress all enjoy government-financed health care with few restrictions or prohibitive fees. They are never turned away for pre-existing conditions or denied care for what an insurance company labels "experimental treatments."
The rest of us deserve no less.
We call on the presidential candidates to support HR 676, the National Health Insurance Act- an expanded and improved Medicare for all that:
• provides complete medical, dental, vision and long-term care
• eliminates deductibles, co-pays, hidden fees
• allows you to choose your doctor, lab, hospital, health care facility
• is completely portable and not tied to employment
• is free from interference or second-guessing by insurance companies.
We should have these conversations out in the open. The vagaries of what it politically possible should never be the outer edges of the debate. Let's actually find out if America rejects a Medicare-for-all system; they certainly haven't rejected Medicare. It takes an organization like the CNA to jumpstart this debate. Good for them.
Without a health care plan of his own that any legislator would back, Arnold Schwarzenegger is left to mold the Democratic leadership plan in his image. He came out strong yesterday in the opening salvo in the negotiating process:
With the budget resolution, the clock starts for the rest of the legislative session in Sacramento. The Assembly and the Senate have until September 14th to pass bills before them and send them to the Governor's desk for signature. And obviously the centerpiece of the session is health care reform. AB8 will be the organ for Democratic legislative leaders and the Governor to come to an understanding about how they want to fix the state's health care crisis. And the people are weighing in and saying that their preferred solution has a different bill number; SB 840.
UPDATE by Brian: Here's the PDF of the relevant health care poll from Field. Over...
California Speaks: We Want Single Payer
by Senator Sheila Kuehl
On August 11th, 2007, at the culminating and boisterous OneCareNow rally in Los Angeles, as well as eight coordinated "listening" events around the state, sponsored by Blue Shield and the California Endowment, among others, a random selection of thousands of Californians spoke out overwhelmingly in favor of major health care reform.
At the largest rally of the year, more than two thousand advocates, patients, nurses, doctors and universal health care fans gathered on the steps and lawns of the Los Angeles City Hall to excoriate a health care system that does nothing but devastate working families with systematic cancellations, denials and delays in care. This doesn't promote health, it isn't care, and it certainly isn't a "system"-- it's traumatizing and often deadly for people who thought they would be given care, but, instead, got nothing but a tangle of insurance red tape.
Convinced that single-payer universal health care is the only hope for fixing our broken health care system, they gathered to support SB 840 (Kuehl), the only truly universal health care plan proposed in legislation that is shown to contain costs, improve health care quality and allow Californians total choice of their doctors and hospitals.
This passage from Anthony Wright on the deabte over SB 840 (the single-payer universal health care bill), which passed the California State Senate yesterday, caught my eye. I think it's a good lesson on how to deal with Republicans who will lie and lie about how health care is delivered in this country and abroad. It's important for every Democrat who wants to move forward on this issue to read this.
Thanks to Frank Russo for informing us that Sheila Kuehl's SB 840, the single-payer health care plan which is the the result of years of work and refining, has passed the California State Senate for the second straight year. The mostly party-line vote was 22-14, with only Lou Correa voting with the Republicans against the bill.
Speaker Nunez and President Pro Tem Perata have health care bills up for votes, likely tomorrow, that are expected to pass. Then the other chamber gets a crack at them all, then there will be some process of negotiation and merging of all of these health care-related bills resulting in whatever the Governor and the Legislative leaders decide is an acceptable final product. It's great that, by virtue of continuing to push SB 840 and not backing down, Sen. Kuehl will be in that room for those negotiations. So this is not a fool's errand, it's a vital step to continue to push this state toward universal single payer healthcare and show the nation that it can be done.
People (myself included) are giving you a lot of crap in the comments of your post about the Republican wonder Arnold Schwarzenegger. In it you suggest that Arnold is governing like a Democrat (though an imperfect one), which merits praise. May I suggest to you that Arnold is simply getting closer to governing the way he ran and that it is sharply contrasted to his 2005 "year of reform", skewing people's perceptions. He is not now, nor will he ever be a Democrat. Arnold is a moderate Republican and is governing like one. There are serious differences between what a Democrat would do in office and what Arnold does.
Yesterday I attended an event at the Santa Monica Democratic Club with State Senator Sheila Kuehl, who's devoted the latter part of her legislative career to promoting and advancing SB 840, the single payer universal health care bill that the Governor vetoed last year. Kuehl keenly understands the political dynamic of the health care debate in the state this year. The Governor has vowed to pass a "universal" health care law this year, and he has vowed to veto Kuehl's bill. Nobody has brought the Governor's initial program forward as a bill, and it's likely that nobody ever will. Both Senator Perata and Speaker Nunez have bills that are making their way through the relevant committees. Sen. Kuehl's bill has passed as well. The Republican Assembly and Senate have forwarded piecemeal bits of legislation that don't attempt to deal with health care in any kind of comprehensive way.
Over 2000 school employees and nurses formed an impressive sea of blue and red as they packed the grounds on the north side of the state capitol on Tuesday to call for health care for all. More specifically, they wanted legislators and the governor to know they want single payer, also know as Medicare for All. Senator Sheila Kuehl, who spoke at the rally, is carrying the bill they want - SB 840.
