California's healthcare initiative: Where are the feds?

Today's debate focuses on the problem at the federal level. Previously, Wright and Zingale discussed the basics of Gov. Arnold Schwarzenegger's healthcare initiative, the wisdom of using insurance as the mechanism for universal healthcare, the burdens of the individual mandate on those who can't or don't want to pay for it, and the experience of similar statewide plans.

The future won't wait By Daniel Zingale

Gov. Arnold Schwarzenegger has always been the type of leader who wantsto tackle big problems rather than waiting for someone else to do it for us.

It's no different with our broken health care system. California has 6.5million people without insurance, and costs are skyrocketing. Medical billsare one of the leading causes of personal bankruptcies. We simply cannotafford to wait for Washington to take action.

The Governor's health care plan will work for California because it embracesshared responsibility and focuses on the reasons that costs are out ofcontrol. We all contribute to the solution, and we all benefit.

This was a point of consensus at the Governor's Summit on Health CareAffordability last July. He brought together some of the nation's bestthinkers to talk about solutions for California, and everyone felt that wecould achieve lasting reforms if we included all stakeholders.

At the national level, the Governor is thrilled that his proposal foruniversal coverage in California has heightened the discussion on healthcare. It would be wonderful if this nationwide buzz turned into a plan thatworks for all Americans.

But a national approach can only work if it is put into action, andWashington is a long way from implementing positive reforms. Cutting$100 billion from Medicare and Medicaid over the next five years as has beenproposed by the feds would shift millions of dollars in costs to the statesand reduce reimbursements to health care providers. This would jeopardizeour most vulnerable populations and increase the hidden tax that we all payto cover the uninsured.

The argument that "health care is a federal issue" was also used againstCalifornia's HMO reforms. Had our state not enacted an HMO Patients' Billof Rights in 1999, we'd still be waiting for Washington to protect patients.And what about stem cell research or global warming? California has had totake the lead on many important issues facing our nation and world. Likethe Governor often says, we can't wait for the federal government to solveour problems because the future doesn't wait. We need solutions now.

Nonetheless, the Governor's plan does include a strong partnership with thefederal government. It is consistent with the Four Cornerstones ofValue-Driven Health Care Initiative, which includes improving health caretechnology, measuring and publishing quality-of-care information, measuringand publishing pricing information, and promoting quality and efficiency ofcare.

By expanding coverage in California, the state also will receive our fairshare of federal money in Medicare and Medicaid reimbursements. This willadd $10-15 billion into our system, finally compensating doctors andhospitals for the care they provide for low-income patients who currentlydon't have coverage. And the Governor's proposal to allow all Californiaemployees to pay their share of health care costs on a pre-tax basis rewardspersonal responsibility and makes health care more affordable.

California's health care system is broken, and there is tremendousenthusiasm among stakeholders, members of the Legislature, and certainlythe Governor, to fix it. With the federal government as a partner and allstakeholders involved, we can lead the way to a healthier state, and becomea model for the nation.

Daniel Zingale is senior advisor to Gov. Arnold Schwarzenegger and chief of staff to Maria Shriver.

Do it right. Do it nowBy Anthony Wright

Daniel, it's the end of the week and I feel we just cleared our throats.Maybe the LA Times' Dust-Up might invite us back in a few months, when thepolicy choices will be more sharply defined.

Until then, Californians who want to follow can get reports from Sacramento(and rants from me and others) at the Health Access blog, updated daily. Governor Schwarzeneggerhas a useful site to track his proposals aswell.

But, readers, we need you not just to be informed, but active, in thisdebate on health care reform. Too often these debates about health care inSacramento or DC turn into fights among industries: hospitals vs. insurers,doctors vs. medical groups, HMOs vs. drug companies. We need thefull-throated voice of health care consumers to be heard this year.

There's a huge opportunity not just to expand coverage but to providesecurity to Californians who fear they are a job change or recession awayfrom being uninsured.

There's also a challenge to make sure the reform is in the interest ofpatients and the public, and not the industry stakeholders. Legislators willget an earful from the insurers who discriminate based on health status, butwill they hear from people who have been denied because of "pre-existingconditions" or other factors? Employers who don't cover all their workerswill have their say; but will legislators hear from the uninsured workers,or the employers who provide coverage but have to compete against those whodon't?

The leadership for positive change in health care needs to come not justfrom the legislature, or the governor, but from you. Write your statelegislator. Submit a letter-to-the-editor. Join a campaign with my and otherconsumer groups at Tell your story. There's nobodywho can better define what "affordable" coverage is, what "sharedresponsibility" should actually mean for individuals, for employers, and forgovernment.

Over the week I mentioned some disagreements with the governor's plan, eventhough it's great that he has joined with legislative leaders in making thisthe priority for this year. But when something gets passed this year, itwill not be the governor's current proposal, or that of any specificlegislator, but it will be shaped by the actions we, the public, take.

I concur with Daniel wholeheartedly on this last point: we can't wait forWashington, D.C. to act. If anything, President Bush's proposals take us inthe wrong direction, underfunding children's coverage programs, encouragingunderinsurance, and undermining employer-based coverage. Californiapolitical leaders need to be active in ensuring that the current children'shealth program is renewed and sufficiently funded.

For those of us who believe in group health coverage—and the bigger thegroup, the better—the best solution would be at the national level.

But the most effective way to win national reform is to start the momentumat the state level. Passing meaningful and successful reform here inCalifornia will not only provide real help and security to Californiansright now, but will instigate even more pressure for reform instatehouses across the nation, in Congress, and among presidentialcontenders.

Here are some simple guidelines: Build on what works. Cover everybody. Cutcosts, not care. Fund it by asking everyone for their fair share. Poolpeople together to get the power of group purchasing. Break down barriers tobeing covered. Set strong standards.

And finally: Do it. Do it right. Do it right now.

Anthony Wright is the executive director of Health Access California, the statewide healthcare consumer advocacy coalition, which hosts a daily blog here.

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