Health Care in CA is Dead

This story just broke.  About 45 minutes ago, the California Senate Health Committee voted 10-1 not to move the bill out of committee, rendering it dead.

http://www.bizjournals.com/...

There are a lot of lessons from California's long, painful year at trying to get universal coverage.  I will name just a few:

1. Developing a health care reform proposal using 4-5 staff in the Governor's Office, without the involvement of major stakeholders or the Legislature is a loosing strategy.  Hillary Clinton learned the hard lesson of developing a plan behind closed doors in 1993 and the mistake of not developing the plan with the input of the Congress.  An inside access only model to policy development in the Executive Branch is a nonstarter.

2. If you are Republican Governor, you need to work with the Republicans in your legislature if you want their support.  Failure to consult with the members of his own party in the process of drafting his proposal meant that not a single legislator was willing to carry the Governor's bill.

3. Drafting a proposal that competes with the plans proposed by the President Pro Tempore of the Senate and the Speaker of the Assembly and then vetoing their bill when it come to you for signature is probably not a good way to build support with the legislators who do want health care reform.

4. As the IOM has concluded, states cannot achieve universal coverage on their own.  Massachusetts, Vermont and Maine are all struggling.  California's projected $14 billion budget shortfall didn't help either.  And then there is the economy and the sub-prime crisis that are pushing health care off the top of the agenda.

Governor Schwarzenneger deserves our thanks for trying to make good on his pledge of universal coverage this year.  But his plan had something for everyone to hate and the process dragged on so much longer than anyone anticipated, that the policy window slammed shut and the budget deficit reared its ugly head before it could be done.  And lots of powerful interests were lined up against it: the doctors, nurses, businesses, unions, tobacco industry, insurers, public hospitals, etc.

And even if the legislature had approved the bill, the financing was going to have to be put to the voters in November as a ballot initiative.  The last 5 times there has been a ballot initiative on health care on the CA ballot it has been soundly defeated.

The main sticking points were over the following issues;

An individual mandate
A tobacco tax
Covering undocumented workers
The amount available for subsidies
The plan to lease the state lottery for revenue
Universal coverage

It will be imperative for the next President to take on this issue early in his/her presidency.  The President and Congress must be willing to work together to act quickly and interest groups must at least be heard.  And an effort will need to be made to find common ground with Republicans who are social moderates.

Everyone had hoped California would be the next state to enact truly universal coverage.  

We will have to wait another day.

•  tips!

  by Helenann on Mon Jan 28, 2008 at 04:38:13 PM PDT

  •  Thank you for covering this

    I don't agree with all of your analysis. I believe our Gov. had an opportunity to sign a much better bill, but chose not to. Our best shot in CA will be to get a larger Democratic majority as well as a new Democratic Governor and create a single payer system (CA has more people than Canada, so I don't see why the pool would be too small).

    by Sacramento Dem on Mon Jan 28, 2008 at 04:58:13 PM PDT

    •  I agree

      But I think it will have to be a bill that gives people the option of enrolling in the single payer plan and does not force anyone into it. Mandating anything is not going to be popular.

      I am in conversations to try to get the legislature to consider a proposal similar to the Democratic Presidential Candidates.  One that gives people the option of a single payer plan, but let's those who like their current coverage keep it if they want.  An analysis of this plan for the state of CA found that about 70% of the population would voluntarily elect to go into the single payer pool within one year, covering 95% of the population without an individual mandate.

      It is called CHOICE.  I think it may be the closest thing to single payer we can get.

      http://chpps.berkeley.edu/...

      by Helenann on Mon Jan 28, 2008 at 05:20:25 PM PDT

      •  I have choice in drinking water

        I can either take the perfectly good stuff from the tap or I can pay a bunch for bottled water. If we made a single-payer system available to everyone and had the choice be to get something additional I think that would be more popular than forcing Californians to buy private insurance with all the duplication of effort that goes along with it.

        by Sacramento Dem on Mon Jan 28, 2008 at 05:26:30 PM PDT

        •  Couldn't agree more.

          by Helenann on Mon Jan 28, 2008 at 05:27:27 PM PDT

      •  One of your criteria is getting Rethugs in the

        leg for support.

        On a single payer bill? They won't even support a mandates bill like the one that died.

        If you think you can get their support on any health care reform, there's a Nigerian prince out there who wants your help too.

        Good diary, and I am very glad you diaried this subject here, it needs it, but I take issue with some of your points that are not quite accurate.

        by doinaheckuvanutjob on Mon Jan 28, 2008 at 06:24:22 PM PDT

        •  No one is asking for their support

          But they should be invited to express their preferences so they at least feel they have been heard.

          And maybe they can even figure out how they transition their business out of the sale of health insurance, to providing administrative support and offering regulated supplemental policies to a national plan.

          To call them evil and refuse to talk to them is not the right strategy.  That is the Bush doctrine.

          by Helenann on Mon Jan 28, 2008 at 06:27:38 PM PDT

          •  Well I disagree completely. Our Rethugs in the

            state leg are so RW even moderate Republican voters don't like them, and their party has been at war with itself and the moderates are in exile as the nutjobs have control of the party outside the governor's office (Ahnold represents the moderate faction).

            Talk with the Tom DeLay types as much you want, you won't be dealing with straight shooters but criminal types like Darrell Issa.

            They can be easily marginalized and do not need our help to be given more voice and power. This is smart politics and a realistic assessment. Not Bush doctrine.

            They are already marginalized in the state leg and both the Dems and Republican governor Ahnold don't deal with them because they have already tried. Whenever they've tried, the results are demands to do it their way, and no compromise.

            They are not 'evil' just fanatical and inept politicians who deserve to be marginalized, with the exception of a few individuals such as Tom McClintock who is reasonable despite being extreme, but even he would never agree to any reform whatsoever. If they can't play nice, they are out of the deal. And that is not a partisan Bush doctrine view.

            by doinaheckuvanutjob on Mon Jan 28, 2008 at 07:43:56 PM PDT

          •  I do agree with you about talking with

            health insurance and business and getting them on the table in some fashion to fix the health care problems.

            by doinaheckuvanutjob on Mon Jan 28, 2008 at 08:12:53 PM PDT

      •  Mandating can work and be popular

        The problem with Schwarzeneggers mandate wasn't that it was mandatory, but that there was no guarantee that it would be affordable high-quality insurance. It was a mandate to waste your money on junk insurance while you are struggling to pay the mortgage.

        A mandate to buy would have been hugely popular as part of the vetoed single-payer bill. In fact, single payer without a mandate is probably not going to work.

        Given that most people don't have choice now - they are stuck with whatever their employer offers - I'm not sure that choice is particularly important, either.

        by sdgeek on Mon Jan 28, 2008 at 07:37:40 PM PDT

  •  tattoo these 4 points to Arnold's bicept

    Excellent post.

    by haroldp on Mon Jan 28, 2008 at 05:57:44 PM PDT

•  The California Nurses Association

  also lobbied hard against it because of the individual mandates.  They recognized mandates for what they are: corporate welfare for Aetna.

  by clonecone on Mon Jan 28, 2008 at 04:48:16 PM PDT

  •  Single payer has failed every time on the ballot.

    as a referrendum. Thus we have nothing.

    by doinaheckuvanutjob on Mon Jan 28, 2008 at 06:26:22 PM PDT

•  We definitely need to change

  our health care system in this country.
  One of my friends is currently recovering from surgery in Tijuana. She has dedicated her life to public service (in the schooling system) in in this country. Unfortunately, she found herself in the middle of jobs and her new insurance policy did not cover her surgery because it was 'an existing condition'.
  This is outrageous! This has to change!

  by pileta on Mon Jan 28, 2008 at 04:48:38 PM PDT

  •  Fortunately

    all of the Democratic candidates' proposals will banish this practice of limitations and exclusions based on pre-existing conditions,  It is immoral.

    by Helenann on Mon Jan 28, 2008 at 04:52:17 PM PDT

•  While I respect the efforts of

  Sheila Kuhl, individual states simply cannot resolve the issue of health care.  Medicare for all (except those that prefer to remain with their private insurance companies) is the only viable option.

  by Marie on Mon Jan 28, 2008 at 04:48:46 PM PDT

•  It was a bad bill

  I'm sorry that health care is dead this term, and this one bill stunk. It threw a big burden on the poor and gave all the money to Ahnold's insurance buddies.  Nobody really lined up behind it and many saw this as a ploy by Ahnold.  And then Ahnold stuck knives in people's backs.  Plus which, the sate is broke.

  by Rolfyboy6 on Mon Jan 28, 2008 at 04:50:12 PM PDT

•  This plan's death is welcome.

  There wasn't anything in this plan that would have actually provided universal health care to folks like me who are uninsured. It was a poorly-designed insurance reform that would have caused many more problems than it solved. Its financing was terrible. It had no real cost containment provisions. It had an individual mandate without caps on premiums or defined benefits. It was a really, really bad way to address a serious problem.

  What this should also prove, of course, is that Arnold has little interest in actually helping provide Californians with health care. We're going to have to do this ourselves. Aiming toward 2011 is also a good idea.

  by eugene on Mon Jan 28, 2008 at 04:55:50 PM PDT

•  Bill deserved to die

  As I understood it, this was not single payer health care or even universal coverage, this was mandatory private coverage, which with the growing cost of health insurance wouldn't have been a good thing. Simply calling something health care reform is not enough, the actual plan is extremely important. It makes the difference between being a bonanza for big insurance companies or people actually getting affordable care.  

  by Chrisfs on Mon Jan 28, 2008 at 05:07:46 PM PDT

  •  Arnold

    wanted it to be universal.  He even included all the undocumented workers and their families in his original bill.  But it was stripped out by the legislature.

    I agree that it was not a good bill.

    by Helenann on Mon Jan 28, 2008 at 05:15:39 PM PDT

    •  Bullshit.

      Ah-nuld wanted to force people to line the pockets of the Murder By Spreadsheet industry. He didn't care about "universal coverage." He wanted to give his insurance company buddies universal payback.

      by Pris from LA on Mon Jan 28, 2008 at 05:38:08 PM PDT

      •  I think he made an earnest effort

        including representing business and insurance interests. Thus, the bill became worthless after the all the different animal parts were added to it, it became a beast that couldn't fly or walk, and lost support. Ahnold made as an earnest an effort as can be expected from the big business community to pass universal health care that most consumers would not like much.

        by doinaheckuvanutjob on Mon Jan 28, 2008 at 06:29:51 PM PDT

•  Not dead....

  ...just sleeping. Universal health care is a national Democratic platform. Not strategically smart to "resolve" the issue in just one very important state.

  by Bensdad on Mon Jan 28, 2008 at 05:36:23 PM PDT

  •  Dead in CA

    I agree with your analysis.  The Institute of Medicine concluded several years ago that state's simply can't solve this problem on their own.

    They recommend that they the only way we will get comprehensive reform is to make it universal and a national proposal.

    by Helenann on Mon Jan 28, 2008 at 05:38:23 PM PDT

    •  The Senator who "killed" it....

      ..Sheila Kuehl is very progressive (promoted Domestic Partnership legislation). She killed it because it had no visible monetary means of support (Schwarzenegger's proposals never do --bonds, and not James Bonds are the answer to everything). This was a Republican effort to derail an important Democratic plank.

      by Bensdad on Mon Jan 28, 2008 at 06:08:47 PM PDT

      •  The budget shortfall

        and the cost of the reform are the real daggers in this bill.  In the end, all but one of the Senators on the committee voted against the bill.

        by Helenann on Mon Jan 28, 2008 at 06:11:32 PM PDT

        •  The budget & lack of consumer protections.

          Some of the provisions didn't protect the consumer-- no limits on premiums and no requirements on what must be covered. A lot of Dem legislators, like Mark Leno for example, said that lost their vote too.

          by doinaheckuvanutjob on Mon Jan 28, 2008 at 06:32:16 PM PDT

      •  Arnold killed Kuehl's bill

        when it reached his desk. It was single payer.

        by ellend818 on Mon Jan 28, 2008 at 07:05:09 PM PDT