California's healthcare initiative: Where are the feds?

Gov. Arnold Schwarzenegger has always been the type of leader who wants to 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 6.5 million people without insurance, and costs are skyrocketing. Medical bills are one of the leading causes of personal bankruptcies. We simply cannot afford to wait for Washington to take action.

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

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

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

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

The argument that "health care is a federal issue" was also used against California's HMO reforms. Had our state not enacted an HMO Patients' Bill of 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 to take the lead on many important issues facing our nation and world. Like the Governor often says, we can't wait for the federal government to solve our problems because the future doesn't wait. We need solutions now.

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

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

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

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

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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 the policy 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 Schwarzenegger has a useful site to track his proposals as well.