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Healthcare reform -- now

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In the next 15 to 18 days before the Legislature adjourns, the narrow window of opportunity we have to achieve healthcare reform in California -- reform that expands access for those who don't have health coverage and keeps costs down for those who do -- will start to close. If history is a guide, we can expect an anything-goes campaign in the next few weeks to delay, derail and demonize healthcare reform. We need to focus on some basic truths to keep that campaign from succeeding.

First, for nearly 10 months now, the reform proposals I put forward with Senate President Pro Tem Don Perata have been vetted in the legislative process, fiscally analyzed by academics and scrutinized by the media. Yet you can count on opponents saying, "We're moving too fast; let's slow down." Practically speaking, what they are really trying to do is kill any reform -- delay means death to controversial big-issue legislation. Given more time, the forces against healthcare reform will find ways to take more potshots at the proposals. We don't need a special session of the Legislature later this year. We don't need to punt to the 2008 election year.

There are two main proposals on the table. One is written by myself and Perata, and one is from the governor. Let me explain why I think that the Nuñez-Perata bill is the only one that can succeed so we can begin to deliver what Californians need.

Basically, our legislation would call on employers to spend at least 7.5% of their payroll on worker healthcare, with employees also contributing to the premiums. The state would subsidize insurance for the poor. This plan builds on the current employer-based system and only requires a majority in each house of the Legislature for passage.

The governor's plan, on the other hand, would require everyone to have insurance, and funding for it would come from a levy on doctors and hospitals in addition to employer contributions. That levy would count as a new tax, according to the legislative counsel, and new taxes require a two-thirds vote in the Legislature. That in itself is a backdoor way of killing healthcare reform because it requires more bipartisanship than can be delivered. The governor's inability to get Republican senators to vote for his state budget -- and that's more a knock on them than him -- shows the folly of trying to win support from the hyper-partisan right.

Does this mean that I don't want to include my Republican colleagues in the process of creating reform? Not at all. But should the fate of healthcare reform be dependent on far-right Republican senators who only support a laissez-faire/free-market approach that Californians overwhelmingly reject? No way.

If you can't get the funding passed that would allow for every Californian to purchase health insurance, then that simply can't be part of the law. We don't have enough money in the state to cover everyone who doesn't work. And if we can't ensure that everyone has access to coverage, we can't in good conscience turn around and penalize someone for not having coverage.

Opponents of serious reform will trot out the alternative of merely expanding state insurance programs to cover all children. That can't be the only aspect of reform. The 700,000 children in California who don't have healthcare are going to get it, but not at the expense of their parents and grandparents. We should not pit one generation of Californians against another.

Those who want to see more complete coverage also will object to our plan because they'd rather see a single-payer system -- in which a government-run entity contracts with doctors and hospitals and handles all claims.

I embrace the idea; it is a noble goal and may one day prove to be the ultimate answer. It's overwhelmingly supported by legislative Democrats and has growing support from Californians. But in 2007, a single-payer plan would be vetoed by the Republican governor just as he did the version the Legislature sent him in 2006. Sacrificing the good for the perfect doesn't make sense in the world of public policy.

Last week, I spoke at a healthcare rally put on by AARP, marking the final push for healthcare reform. In the 50 feet it took me to walk from the rally site to the doors of the Capitol, I was stopped at least a dozen times by people desperate to have someone listen to the problems they were having in the healthcare system: a woman whose son had come out of a coma after two weeks -- and who could get all the pain medicine he wanted, but no treatment to get to the root of his brain disorder; veterans who could only get care at one of the state's far-flung veterans homes; a woman whose self-employed daughter with leukemia couldn't get coverage.

We're not trying to turn this state into Cuba (with socialized medicine) or Canada (with a single-payer system). We're just trying to do right by these Californians. And doing right by them means doing reform right: a comprehensive healthcare reform plan that makes sense and that we can afford, and doing it now.

Fabian Nuñez is speaker of the Assembly.

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