State’s cover boys for healthcare

There was a revealing comment last week by Assembly Speaker Fabian Nuñez about himself and his on-again, off-again pal, Gov. Arnold Schwarzenegger.

“Let me tell you what we have in common,” the Los Angeles Democrat told reporters, illustrating that his cozy relationship with the Republican governor currently is on again.

“First, we’re both eternal optimists.

“Second, neither of us back down from a fight.

“Third, both of us are committed to healthcare reform.

“Fourth, we both want to be on the cover of Time magazine.”

It was meant as throw-away humor and everybody laughed. But it also spoke the truth and explains one driving force -- lure of the national spotlight -- behind ambitious state healthcare expansion.

Schwarzenegger did land on the cover of Newsweek in April, praised for signing last year’s anti-global warming bill that Nuñez pushed through the Legislature. This year, Nuñez is the main lawmaker on healthcare expansion, which, if achieved, could place the governor on lots of magazine covers.

I read Nuñez’s quote to veteran Democratic political consultant Darry Sragow, who’s a strategist for AARP in its lobbying for healthcare reform. Normally a consultant would wince at a politician being so straightforward. But Sragow laughed and asserted: “I’m glad he said it. That’s a lot of candor.

“It’s what I’ve been saying all along. This is all about their legacies.”

Legacies are built with behemoth leaps, not bitty steps.

That’s why the governor won’t listen to Republican legislators when they tell him he should back off and take small, prudent steps that don’t require a tax increase.

Steps, they argue, such as: Expanding the state coverage pool for uninsurable people with pre-existing conditions. Allowing workers to keep their insurance while moving from one job to another. Expanding clinics that could treat the uninsured more economically than emergency rooms. Permitting people to pay for medical care through tax-free health savings accounts. (The feds allow this.) Raising Medi-Cal reimbursement rates, now the lowest in the nation, to attract more doctors and increase access to healthcare for the poor.

“There are so many common-sense things we can do before rushing into a program that will cost way more than we can afford,” says Assembly GOP leader Mike Villines of Clovis.

“We’ve wasted six months playing politics.”

But even the Republicans’ modest steps could cost around $2 billion -- compared to Schwarzenegger’s tax-hiking $12-billion plan -- and the state doesn’t have any spare change. Other health and welfare programs would have to be cut.

“We’d have to prioritize,” says Senate GOP leader Dick Ackerman of Irvine. “If healthcare’s truly a priority, then it’s got to be treated as such.”

But Schwarzenegger is searching for the truly colossal. Any California healthcare reform must open the nation’s eyes, he tells legislators. People across America must look to this state as the healthcare leader, to its plan as the national model.

Schwarzenegger wants to require everyone to buy health insurance. This would increase the insurance pool and help to lower coverage costs. At the same time, insurers could not turn down consumers because of pre-existing conditions. That’s adamantly opposed by California’s largest insurer, Blue Cross. The governor also would require employers either to provide insurance or pay into a statewide pool that would finance coverage for workers.

Employers would be docked 4% of their payroll under Schwarzenegger’s plan; 7.5% under the Democrats’ that he has rejected. The L.A. Chamber of Commerce endorsed the governor’s idea Monday. Hospitals would be hit for 4% of their revenue, a plan they’ve endorsed, realizing it would trigger $1.7 billion in extra federal funds. Some large retailers are talking up a sales tax increase.

And the voters are on Schwarzenegger’s side -- not Republican legislators’ -- according to a poll to be released Friday by the Public Policy Institute of California.

Asked whether California needs major or minor changes in its healthcare system, 72% answered “major.” This included 63% of Republicans.

Voters also overwhelmingly favor requiring everyone to be insured. Nuñez, other Democrats and labor unions have fought this, arguing that many people couldn’t afford it. But the concept may have gotten a huge boost Monday when presidential candidate Hillary Rodham Clinton proposed it as part of her national healthcare plan.

The poll indicated that voters are split over whether all children -- even illegal immigrants -- should be guaranteed health insurance. Never mind that federal law already guarantees illegal immigrants medical care at expensive emergency rooms.

The most important state issues, according to the poll? Not surprisingly: immigration and healthcare.

“The immigration thing raises a red flag,” says Mark Baldassare, the policy institute president and pollster. “But clearly, the public is focused on the healthcare issue.”

Schwarzenegger’s proposed tax hikes would require a two-thirds majority vote of the Legislature. And Republicans won’t allow that. The governor still clings to hope that Republicans at least will vote to put a tax measure on the ballot so the electorate can decide.

“It’s not going to happen,” Ackerman vows.

That leaves Schwarzenegger and the Democrats with no option, they think, but to compromise among themselves on a jumbo, eye-catching plan and pass it with a majority vote -- something, Republicans say, that the governor promised not to do. Then Schwarzenegger and his allies would have to sponsor a tax initiative for next November’s ballot, battling Republicans and probably Blue Cross.

In all their maneuvering and dealing over healthcare, the politicians should heed the admonishment of the ancient Greek physician Hippocrates: “At least. . . do no harm.”

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george.skelton@latimes.com