Commentary : Four Ways to Look at Deukmejian’s Employee Health Insurance Plan

The Deukmejian Administration recently proposed a plan that would require every business--extending even to the self-employed--to provide health insurance to its workers. If implemented, the proposal would give California one of the most ambitious state-mandated health insurance programs in the nation. The Times asked four Orange County residents who are either knowledgeable about the health-care field or who would have a vested interest in the implementation of such an all-encompassing program to share their opinions--positive and negative--about the proposal.

At least 5 million Californians are without health insurance; an unknown additional number are underinsured. Although some of these people manage without health care, the costs of caring for the rest are shifted to taxpayers in a variety of ways. Other significant costs to society are lost productivity and a drain on other social services as a result of lost earning power and increased dependence by these families on government.

By addressing the issue of access to health care, the governor has joined those of us who are working to find solutions. I applaud his initiative and think this proposal is a move in the right direction. Focusing attention on the issue is a necessary first step.

The proposal, by mandating business to provide health insurance to its employees, will inject new dollars into a complicated “system.” Past experience teaches us that funds alone are not a solution, that these funds have tended to lead to an upward spiral of health-care costs. It is not clear how costs will be monitored and constrained while physicians and hospitals will be encouraged to participate in Medi-Cal in increasing numbers.

Additional funding seems a necessary but not sufficient step toward universal access to cost-effective care. Furthermore, a way to track utilization of these new benefits to ensure that they are used appropriately will be needed.

A critical issue is the definition of what care these newly insured will have access to. Who will set the priorities for these benefits, and by what mechanisms? Agreement on what constitutes adequate or even basic benefits is best achieved on a local or county level, rather than on a statewide basis. I believe that the state should support local efforts to reach such consensus and the counties should be assured their fair share of funding and freedom in the administration of the governor’s program.

The governor’s desire to address the plight of the medically uninsured is most welcome.

His proposal is neither comprehensive nor a panacea, but it deserves careful study. The concept of a public-private partnership is increasingly accepted as a means of creating innovative solutions to a “system” that has had too little systematic planning to earn respect from those who are its consumers.