Shaping Up for November

Next November’s ballot will not, after all, be a battleground for rival health care proposals, although there is a possibility that three alcohol tax proposals may be put before the voters. As matters now stand, only one health insurance initiative is proposed, but it, too, would include an increased tax on alcohol, challenging at least one, and possibly two other proposed liquor tax initiatives.

Once again, the proliferation of propositions is a sad measure of the inertia of the state Legislature. Voters will be asked to decide highly complex problems more properly the business of a careful and open legislative process. Unfortunately, competing interests have blocked any substantial legislative progress in addressing the problem of the 5 million Californians with no health insurance of any sort, let alone the under-funded Medi-Cal and medically indigent adult programs that are crippling hospital services and gravely limiting primary medical and dental care. At the same time, the power of the wine and liquor interests in the Legislature has maintained a level of taxation on wine, beer and spirits that seems inappropriately low against the background of the public health costs generated by those products, both in basic health care and in emergency-room services.

The two principal health provider organizations, the California Medical Assn. and the California Assn. of Hospitals and Health Systems, have postponed until 1992 plans for initiatives of their own. They have been focusing on a proposition mandating that all employers provide health insurance. That had been the subject of legislation by Assembly Speaker Willie Brown (D-San Francisco); now it is one of the issues being reviewed by a state commission created when the Brown proposal failed.

Health Access Foundation, a broad coalition of consumer groups, struggled with an even broader initiative. It would have moved towards the Canadian model of a stronger governmental role in assuring universal health insurance while also protecting the aged against impoverishment when faced with long-term nursing home care. But the sponsors have decided to postpone their ambitious initiative at least until 1992 .

That leaves only one specific health care proposal under consideration, a universal health insurance plan sponsored by California 2000, a Los Angeles group led by Michael Weinstein, head of the AIDS Hospice Foundation. It is based on legislation authored by Assemblyman Burt Margolin (D-Los Angeles) during the last session of the Legislature. It relies on a variety of funding sources, including an alcohol tax, to assure the availability of health insurance for all. It would maintain the current reliance on private health insurance while authorizing the state to negotiate low-rate group policies for small businesses and others now without insurance or forced to pay very high premiums.

Yet another group is preparing to circulate petitions to qualify a major increase in the alcohol tax of California. Assemblyman Lloyd G. Connelly (D-Sacramento), is originator of the plan. The state’s wine, beer and liquor taxes taken together are the lowest in the nation. Under provisions of the initiative, they would be among the highest, with a revenue increase of $800 million a year at present levels of consumption. The proceeds would be divided five ways, one-fifth going to the state’s beleaguered hospital emergency rooms and trauma centers, with lesser amounts for such projects as alcohol and drug treatment and prevention and community-based mental health programs.

The wine, beer and distilled spirits industries are working together with an alternative of their own, providing for a more modest increase in alcohol taxes that would bring in almost $200 million a year, less than half that projected under the California 2000 health care initiative and about one-quarter of the Connelly alcohol tax proposal.