Fixing a Sick Health System

In the spirit of the season, thanks again to everyone who sent words of encouragement, donations or offers of medical services to Marina Tamayo, the widowed cancer patient whose family hosted last week’s “Yard Sale for Cancer Patient” in Alhambra.

Marina, who was turned down for health insurance because of a “pre-existing condition,” is still sorting out her options and I’ll keep you posted. But now I want to move on to the story of a lawmaker who’s trying to do something for people like Marina.

Long before Keith Richman became a doctor and took over his father’s medical practice in the northeast San Fernando Valley, he heard dinner-table conversations about the importance of doing for others. So when Richman was elected to the California Assembly four years ago, the Northridge Republican couldn’t think of a better service than fixing the state’s healthcare mess. Nor could he have tackled a hairier beast.

“When I first went to the Legislature, I remember speaking about the crisis in healthcare, and the crisis is worse now,” says Richman. “Every day, we read about hospitals closing or trauma centers on the brink of collapse, or about individuals unable to get the care they need.”


We’ll all be dead before the federal government gets off the dime. So Richman and Assemblyman Joe Nation, a Marin County Democrat, have been hosting town hall meetings around the state, trying to rally Californians.

As they see it, the biggest strain on the healthcare system is the growing army of uninsured, which now numbers 6.4 million Californians, more than 1 million of whom are children.

And who are they, exactly?

“Predominantly, they are not living off the government dole,” Richman says. “About 85% are working adults or their children, and typically these adults work for small businesses.”

Richman is opposed to government-run universal healthcare for them and everyone else, because he doesn’t trust the government to do the job efficiently or economically.

Here’s what he’d like to see:

If the owner of a small plumbing company wants insurance for himself and his employees, he’d go to a quasi-public board that would put him into a pool with other small employers or self-employed individuals. The board would then go shopping for the best bulk rate available from a health insurance company. No individual could be denied insurance because of a preexisting condition, as Marina Tamayo was.

For families that still couldn’t buy in, Richman would offer either a subsidy or a tax credit. But he’d like to see most of those families pay at least a percentage of the cost, based on income.


Another way to chip away at the huge number of uninsured, Richman says, is to take full advantage of matching federal funds for Medi-Cal and Healthy Families programs.

Due to bureaucratic sloth, roughly 1 million uninsured children in California qualify for those programs but haven’t yet been enrolled. As a result, the state is forfeiting millions of federal dollars. California is also dead last in the nation in reimbursement to Medi-Cal doctors, which is forcing many physicians to slam the door on patients.

“The cost of a takeout pizza is more than our Medi-Cal reimbursement for an office visit” -- about $14, Richman says.

Another of Richman’s discoveries is that 1.8 million of the 6.4 million uninsured Californians earn three times the poverty income or more.


That still leaves them a few miles shy of Easy Street but, as Richman sees it, they ought to be required to pay for catastrophic coverage.

That way, in the event of an accident or a serious disease, the burden will stop falling on hospitals, taxpayers and the insured, whose premiums are priced to offset the cost of treating the uninsured.

“Everyone in California should be required to have at least catastrophic in the same way that you’ve got to buy car insurance,” says Richman, who is working out the details on how to enforce such a requirement.

In the coming months, Richman says, we can expect a package of bills promoting all these reforms.


I know what you’re asking.

What’s the cost to you?

Not all that much, actually.

Richman estimates it would cost between $4 billion and $5 billion to cover the 6.4 million uninsured Californians, and he would divide the cost among businesses and their employees, the federal government (through available matching funds) and the state.


The state portion would be about $1.5 billion. Richman would pay for it by eliminating a tax loophole enjoyed by some insurance companies, and by putting a cap on tax deductions for health insurance premiums.

And speaking of caps, Richman says we all need to talk, very soon, about the cost of demanding an MRI every time we have a headache and insisting on super-expensive new treatments for terminally ill patients.

But that’s a battle for another day. Richman expects to be tied up in the current one for months.

Taking aim at his reform proposals will be profit-driven medical insurance executives, organized labor bosses demanding Cadillac insurance plans, and lawmakers who would break out in hives over requiring every Californian to pony up for catastrophic insurance.


Nothing new in any of that. For years, competing naysayers have held out for the most self-serving healthcare remedy. And the result?

Forty million-plus Americans with no health insurance.

The shuttering of hospitals across California.

And a yard sale for a cancer patient.



Note to readers: All correspondence for Marina Tamayo can be sent to 3010 Sherwood Ave., Alhambra, CA 91801. You can reach the columnist at and read previous columns at