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There’s no better time to find a healthcare remedy

Sacramento

The stars are in rare alignment this summer for state healthcare reform.

Gov. Arnold Schwarzenegger really does enjoy these victory laps.

The governor has been trotting all over Earth, waving to cameras and taking bows for last summer’s global warming legislation that he actually had little to do with, except to sign it.

Major healthcare reform would punch his ticket for another year of victory jaunts -- and a greatly enhanced legacy.

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Democrats, meanwhile, are on their best behavior, eager to be deemed deserving of some term limits flexibility, which is expected to be offered voters at the presidential primary Feb. 5. Healthcare is their cause anyway, but this summer is an especially important time to look bipartisan and productive.

There’s not only desire in the Capitol, but demand among the public.

Mark Baldassare, president and pollster of the nonpartisan Public Policy Institute of California, says voters “see this not as a Republican or a Democratic issue. It isn’t just some abstract public policy issue. It’s a personal issue. Many are concerned about the rising costs of healthcare and medical insurance.”

Baldassare released a poll last week showing that 75% of voters consider it a “big problem” that so many Californians (6.5 million) don’t have medical insurance.

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Other findings:

* 71% think “major changes” are needed.

* 65% favor requiring everybody to be insured, with the costs shared by employers, healthcare providers and individuals.

* 58% think the federal government should provide national health insurance, even if it requires higher taxes.

Baldassare, however, cautions state politicians: “At the beginning of the year, there was big fanfare about healthcare from Sacramento. But people have seen little progress.”

He says the slow pace apparently is lowering public confidence in the ability of Schwarzenegger and the Legislature to accomplish much -- a trend that lawmakers need to reverse before the electorate votes on term limits.

Power is centered in the Republican governor and Democratic legislative leaders, but GOP lawmakers can’t be ignored -- or at least shouldn’t be.

There’s an argument about whether healthcare reform requires a two-thirds vote of the Legislature -- in which case some Republicans would need to climb on board -- or whether it can be passed by a simple majority. The answer depends on whether requiring employers to pay into a statewide money pool for uninsured workers’ healthcare is a tax or a fee. A tax requires a two-thirds vote; a fee doesn’t.

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When Schwarzenegger’s 2006 reelection opponent suggested an employer healthcare mandate, the governor bellowed that it was a “tax.” When Schwarzenegger himself proposed it, he called it a “fee.”

“I don’t get caught up in these details,” the governor recently told reporters. “I want to create healthcare ... and to me I look at it as a fee.... If someone else wants to call it something else, they can figure that out later on.”

“They” would be the courts.

Republicans vow that, unlike Schwarzenegger, they won’t break their pledge not to raise taxes.

“We’re not going to do a tax in this Legislature,” Assembly Republican leader Mike Villines of Clovis told me. “We’re not going there. Period.”

Schwarzenegger gets credit for setting the healthcare agenda this year and making it the Capitol’s No. 1 issue. But his own specific plan never has generated much support in the Legislature or among interest groups -- business, labor or medical. The governor hasn’t even found anyone to introduce his bill.

The operative legislation is the product of Democrats: Assembly Speaker Fabian Nunez of Los Angeles and Senate leader Don Perata of Oakland. They merged their proposals 10 days ago. The highlights:

* Employers would be required to spend 7.5% of their payroll on workers’ healthcare. Schwarzenegger had proposed 4%, but also wanted to sock doctors 2% of their income, and hospitals 4%.

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* Insurers would have to spend at least 85% of premiums on medical care. That’s borrowed from Schwarzenegger’s proposal.

* The state would subsidize insurance for the poor, including children.

* Insurers would subsidize state coverage for people whose “preconditions” prevent them from getting private insurance.

When Democrats merged their bills, “the world changed,” says Darry Sragow, a political strategist for AARP. “The Democratic plan now is the reference point. People must begin to choose sides.”

AARP’s principal goal is to make sure that affordable insurance is available for people between ages 50 and 65, when they qualify for Medicare. In that 50 to 65 range, Sragow notes, health is deteriorating and many can’t get insurance. “They’re naked without coverage.”

Sragow believes that the aging baby boomer bloc will pressure Sacramento -- and ultimately Washington -- into healthcare reform.

“We’re undoubtedly the most narcissistic generation this country has seen,” he says, speaking as a baby boomer. “I don’t think baby boomers are going to allow government to deny them healthcare.”

But Republican legislators and the business lobby, separately, are seeking more modest proposals: Maybe expanding the state coverage pool for uninsured people with preconditions. Allowing workers to permanently retain their coverage after losing their jobs. Making sure all kids are covered. Expanding clinics in shopping malls.

Even that could cost $2 billion annually, compared with Schwarzenegger’s $12 billion.

Some business interests gingerly are thinking about proposing a sales tax increase to finance healthcare reform and offering it to voters as a ballot initiative.

That’s because they -- and many political players -- see some form of universal coverage as inevitable, and they’d like to help shape the product.

Republicans want to be seen as politically relevant, but not obstructionist. They’ll need to be more conciliatory. But Schwarzenegger can’t afford to dismiss them, as he did on global warming. This time, they can help scuttle any legislation in court or at the ballot box.

Whatever ultimately passes, it must be produced this year. The Capitol likely will turn into a pumpkin after the term limits election in February.

The stars are aligned now, but the politicians shouldn’t be just staring up and fantasizing. They need to act. That means compromising and not shooting for the moon.

george.skelton@latimes.com


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