Almost one year ago, a state bill mandating universal health care for all Californians sat on Governor Arnold Schwarzenegger’s desk. The bill, SB 840, would require the funding of all health care costs to be turned over from private companies and create a single payer health care system controlled by the state. Written by our neighboring state senator Sheila Kuehl (D-Santa Monica), the bill was co-authored by 23 other state legislatures, supported by over 380 statewide and national organizations, and passed with majority support in both houses of state congress. Gov. Arnold Schwarzenegger vetoed SB 840 that September in 2006, saying that “socialized medicine is not the solution to our state's health care problems.” This fear of socialized medicine, along with his concerns about the financial risks involved with universal health care, is reflected in the opinions of most of SB 840’s opponents.
Yet there is no question that Californians are becoming increasingly fed up with the current health care system. According to the nonpartisan Field Poll conducted this past August, 69% of Californians are dissatisfied with the current health care system with 42% of participants saying that they are very dissatisfied.
Escalating public disapproval of the way private insurance companies are handling our health care system stems from a number of economic and social ills. There are an increasing number of Americans, with and without health insurance, facing either economic or health crises because of the cost of receiving health care. In fact, half of all the bankruptcies filed in the US are due to medical costs even though three fourths of those filing for bankruptcy have health insurance. Even for those who are paying for health insurance, many have to deal with overwhelming deductibles, co-pays, and denial of payment for essential care due to various loopholes in insurance contracts. In many instances, having a pre-existing condition (of which there are hundreds), can entirely exclude you from getting health insurance. As a result, 18,000 people die each year because they either couldn’t get or couldn’t afford health insurance, and it is now the 7th leading cause of death in the US.
At least those that are receiving care in the US are getting some of the best medical attention in the world, right? In fact, this a common misconception about American health care. Although the US spends more than twice as much on health care than any other industrialized nation (both per capita and as a percent of gross national product), the quality of health care in the US is ranked by the World Health Organization below all other industrialized nations at 37th for quality, access, and efficiency of care.
So, 69% of Californians are dissatisfied with our current system of distributing health care- what serious health care reforms can we hope for in the future? Lawmakers and politicians across the nation have put forth a variety of proposals and legislature that generally fall into three categories: 1) retaining the current system with few alterations and allowing free-market competition to solve current problems, 2) reforming the current system by expanding publicly funded coverage, or 3) implementing a single payer system in which universal health care is offered to everyone and controlled by a government institution.
Those in favor of relying solely on market-driven solutions to improve our health care system bring up several economic and personal freedom arguments. One argument is that if a bill like SB 840 is approved, then socialized medicine would lead to rationed care with longer wait times for standard procedures and limited treatment options for patients. Opponents also argue that a market economy is generally accepted as the most effective way to reduce the cost of consumer goods and services in our country. One point commonly made by those in opposition is that many people in Canada often travel to America to receive medical services that are either not offered in their country or have too long of a waiting line. However, this highly referenced claim was significantly undermined by the findings of a large population study was conducted in 2002 by Katz and colleagues at the University of Michigan.
California Gov. Schwarzenegger has taken a moderate approach in his recent outlines for health care reforms. His plans, which would work within the existing health system structure, would require all Californians to have health care insurance but would not directly pay for individuals’ plans. This type of health care reform, which tries to redistribute the financial burden of health care across business, government, and more wealthy individuals has recently been implemented in Massachusetts by presidential hopeful Mitt Romney. Although it doesn’t solve all of the problems with the current health care system, it addresses the fiscally conservative concerns by maintaining the private sector’s role in health care insurance.
Yet more frequently people are citing the health insurance companies themselves as the source of most of our system’s problems. Even if the costs of premiums, deductibles, and co-pays are brought under control by moderate legislative reforms, the major problems concerning denial of care and exclusion from insurance plans based on pre-existing conditions remain. In a meeting with state legislatures to screen his new health care documentary “SiCKO,” director Michael Moore likened an insurance company denying emergency care to individuals to a fire truck denying its services to a burning house. Referring to a hospital’s need to ask health insurance companies’ permission before providing certain care, Mr. Moore noted “that when someone is wheeled into a hospital that question should never be asked… That is an immoral question to ask amongst a humane society.”
The most radical legislative reform proposed in California is instituting a single payer system under SB 840. This type of reform has been proposed by many of the Democratic presidential candidates and is currently supported by a majority of California state lawmakers.
Supporters of universal health care draw from a long list of examples of successful publicly funded national health care systems. Most notably Canada, Australia, Japan, Russia, and all of Europe have successful single payer health care system in place. All of these countries spend less for their health care systems, and most have better quality medical care than the US provides. When Steve Lindsay of the California Association of Health Underwriters (a vocal opponent of SB 840) was asked by the Assembly Health Committee Chair “Of the top 8 countries, can you name the ones that don’t have a comprehensive health system?” Lindsay was forced to respond that “America does not have one.” In fact, the United States remains the only industrialized nation that does not have a publicly funded, universal system.
In California, a single payer system would completely remove the $136 billion private health insurance industry and replace it with a pooled government run system that would cover all medical costs for all California citizens. People would be able to choose their own doctors, and the medical care provided would include (beyond basic medical care) emergency transportation, dental, vision, and hearing care, prescription drugs, substance abuse treatment and health education, to name a few.
According to the Lewin Group, an established third party organization that analyzes the impact of health reform initiatives, if SB 840 was passed the state of California would save $8 billion in health care costs in the first year alone. Of that amount, $5 billion would be saved in family health care costs. Instead of paying for premiums, co-pays and uncovered treatments as medical conditions arise, people would have a constant 3.8% income tax that would effectively “smooth out” health care costs to avoid any individual medical expenses that could be financially devastating. Under the bill incomes under $7,000 and any income beyond $200,000 would not be subject to the 3% tax, removing financial burden from the poor and not over-taxing the wealthy. An 8% tax would also be implemented on business revenues, but would replace any current health care costs paid by employers.
After Gov. Schwarzenegger vetoed SB 840 last fall, state senator Sheila Kuehl re-introduced the bill on February 27th, 2007 in a crowded Sacramento hearing room standing beside hundreds of the bill’s supporters. The bill currently has 43 co-authors and is supported by a gamut of organizations including Physicians for a National Health Program, California Nurses Association, the California Federation of Teachers, California School Employees Association, Health Access California, League of Women Voters, Service Employees International Union, as well as several religious and elderly groups, among hundreds of others. In July the single payer bill passed both the state Senate and House of Representatives with majority support, and Senator Kuehl is currently deciding whether or not to send the bill to Gov. Schwarzenegger this year or next year.
Outspoken doctors, politicians, and political activists are calling for a grass-roots effort by communities and local governments to help get single payer legislation passed. City governments, state- and nation-wide organizations, and individual outspoken citizens are preparing to combat the inevitable billions of dollars that will be spent by insurance companies in advertising and lobbying to keep health care coverage in their control. After over four years of steadily growing support for Kuehl’s single payer bill, impassioned citizens and politicians have created majority support for their legislature.
With universal health care hanging in the balance, Californians await the upcoming decision by their Governor.
~Nate Jacobs
References:
1. S. Katz, K. Cardiff, M. Pascali, M. Barer,and R. Evans. (2002) “Phantoms in the snow: Canadians’ use of health care services in the United States.” Health Affairs. 21(3).
2. Aug 2007 Field Poll, available at: http://www.bayareanewsgroup.com/multimedia/mn/news/fieldpoll_082207.pdf
3. SB 840 Lewin Group Report (2004), available at: http://www.healthcareforall.org/lewin.pdf
4. Additional information can be found at these websites:
www.firstresearch.com/IndustryAnalysis/California.asp
www.californiahealthline.org
www.photius.com/rankings/healthranks.html
http://en.wikipedia.org/wiki/Single-payer_health_care
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