Compromising on health care

Among the bills Sacramento is scrambling to pass into law by the end of the legislative session on Sept. 11, perhaps none has received as much interest as healthcare reform. With good reason. In recent days, the U.S. Census Bureau estimated that 18.5% of people in the state -- about 6.7 million, more than ever before -- are uninsured, and the Field Poll reported that 69% of Californians are dissatisfied with the state’s healthcare system.

A week ago, two proposals to overhaul that system were competing in the Capitol. The first, from Gov. Arnold Schwarzenegger, who has made healthcare a pet project for 2007, sought to achieve coverage for everyone by requiring all Californians to own insurance and splitting the cost among consumers, government, employers and healthcare providers. The second, AB 8, sponsored by Assembly Speaker Fabian Nuñez (D-Los Angeles), provided something short of universal coverage with more pay-in from employers.

The differences between the two plans were relatively minor. Both preserved (but imposed reforms on) private insurance, expanded Medi-Cal coverage and pushed cost-containment programs. Nonetheless, Schwarzenegger threatened to veto AB 8, saying it put too much burden on business. Nuñez in turn said he would take the governor’s plan to the floor for a vote it was guaranteed to lose -- a ploy that would have crushed negotiations.

Fortunately, everyone came to their senses, and by midweek started working together to craft a new plan that could and should preserve the core goals of the earlier proposals but still be able to pass in the Legislature. The details are subject to negotiation, but any proposal worthy of support must accomplish a few essential objectives: It should impose an affordable individual mandate, which would keep healthy people in the system and so spread the costs; it should bar the odious practice of insurers refusing coverage to the sickest; it should encourage transparency in pricing and adopt other measures to contain costs; and it should take full advantage of strategies that will boost federal matching money for Medi-Cal services.

Neither Schwarzenegger’s nor the Democrats’ plans were perfect to begin with, and the new bill won’t be either. But the pursuit of perfection shouldn’t get in the way of progress. California must demonstrate that it can address this problem; these leaders are doing just that.

Both camps say they’ll do “whatever it takes” to make healthcare reform work. Solutions could include compromise on the size of employer contributions, compromise on subsidies to make the individual mandate more affordable for the middle class and new, creative ways to pay for the program’s $12-billion annual price tag. All should be on the table. Californians need healthcare relief -- and the entire nation, engaged in its own preelection pondering of healthcare reform, is waiting to see if we get it.