Pushing for Healthcare Shift From the Inside
It certainly isn’t news to any sentient Californian that the healthcare system is the sick man of public policy.
The state’s medically uninsured number 6.5 million, or roughly 20% of all Californians. Trauma centers and emergency rooms, overwhelmed by the cost of serving all patients regardless of their ability to pay, are endangered species; in Los Angeles County, six have closed in the last 14 months.
Working people, meanwhile, shouldn’t be sanguine about their situation. Harry and Louise, the skeptical couple created by the insurance lobby for an
infamous series of commercials attacking the Clinton healthcare reforms, are probably wondering today whether their employers will continue to offer coverage, and whether they’ll be able to afford their share if they do.
“The status quo is not an option,” Bruce Bodaken, chairman and chief executive of Blue Shield of California since 2000, told me recently in his San Francisco office.
Though it might seem strange if the head of the state’s fastest-growing health plan didn’t address the problems buffeting the system, the truth is that Bodaken has stood largely alone for nearly two years. While executives like Leonard Schaeffer of WellPoint Health Networks Inc. trolled for out-of-state merger deals that would improve the health of their personal bank accounts, Bodaken challenged business and political leaders to chip in and provide universal access to medical insurance.
Bodaken’s proposal, introduced in a 2002 speech, would require almost every business to offer its workers a standard plan or contribute a fee to a purchasing pool. Every underprivileged resident eligible for Medi-Cal or other public health programs would be enrolled. All other uninsured individuals would be required to purchase a policy, with no one denied coverage based on a preexisting condition. The government would cover the cost to the extent it exceeded a family’s means.
The idea is to spread the cost of care as broadly as possible, rather than concentrating needy patients on the public tab while private health plans cherry-pick the healthiest -- and cheapest -- customers. Bodaken’s proposal would thus eliminate the cost-shifting subsidy of the uninsured that’s priced into every health premium, while guaranteeing that no Californian is deprived of treatment.
He hasn’t sugarcoated the bad news, either. The plan would require individuals to pay for a significant portion of their own coverage, and the government to finance its own share through a tax or fee -- although if the arrangement was truly broad-based, Bodaken says, any levy would be “relatively small.”
The forthrightness of this presentation was typical Bodaken.
“Prior to that,” says E. Richard Brown, director of the UCLA Center for Health Policy Research, “no insurer had put forth a recommendation for anything that would bring us close to universal coverage.”
Since Bodaken became head of Blue Shield, one of the two major not-for-profit health plans remaining in California, he has shown little patience for the nostrums promoted by his rivals. He scoffs at Schaeffer’s contention that the future of healthcare lies in elaborate information systems that only a huge nationwide conglomerate can afford, noting that his company has remained fully competitive as a single-state plan. “The quality of your provider network, the quality of care -- that’s the differentiating factor between plans,” he says.
None of this has necessarily made Bodaken a consumer advocate’s hero. Critics says his proposal perpetuates a flawed private insurance system in which Blue Shield thrives. Bodaken acknowledges that Blue Shield would benefit from his proposal, but maintains that the only practical path is to fix the system in place, not scrap it outright. “We want the system to survive,” he says.
If anything, the rationale for universal coverage has grown stronger since Bodaken’s speech. Still, the forces arrayed against it haven’t withdrawn.
Bodaken notes that the California Chamber of Commerce and California Business Roundtable have been cool to his plan, even though an academic study estimated that it would save employers as much as $3.6 billion annually in health premiums.
A bill embodying the proposal died in the state Legislature. The reform that did get enacted was SB 2, a version that places more burden on business than did Bodaken’s scheme, and almost none on the government or individuals.
Unsurprisingly, the chamber has made the repeal of SB 2 its top priority for the November election. Bodaken fears that the business lobby’s well-financed campaign attacking the law will kill not only SB 2, but the prospect for any such reform in the near future.
Even so, he finds some grounds for optimism. As the existing system continues to deteriorate, Bodaken believes, the national debate is shifting.
“Some very large corporations are beginning to realize that the cost to them is a massive subsidization of the uninsured,” he says. “And a significant number of voters are concerned about increasing costs and the loss of their coverage. In the last two years, I’ve seen a great deal more discussion and focus than I saw in the previous 10.”
Even within the chamber and Business Roundtable -- neither one a wellspring of progressive thinking on the plight of the uninsured -- Bodaken finds increasing recognition that ignoring the problem won’t bring about a solution.
“There are people in both groups who are interested in finding a means through the muddle,” he says. “As problems emerge, it’s important that there be people at the table who care. We’re continuing to reach out.”
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Golden State appears every Monday and Thursday. You can reach Michael Hiltzik at golden.state@latimes.com.
