A not-so-random walk through SB 562, Legislation to Create a Single Payer, “Medicare for All,” Universal Health Care system for California.
What's the premise?
The twenty-three pages of legislation that constitute SB 562 declares upfront:
All residents of this state have the right to health care...
And that's a very good way to begin!
Who's a resident, and who can sign up?
"Resident" means an individual whose primary place of abode is in the state, without regard to the individual's immigration status...
Every resident of the state shall be eligible and entitled to enroll as a member under the program.
What's it going to cost ya?
A member shall not be required to pay any fee, payment, or other charge for enrolling in or being a member under the program.
(2) A member shall not be required to pay any premium, copayment, coinsurance, deductible, and any other form of cost sharing for all covered benefits.
So, to be clear, that would be Nada. Zippo. Cero. Sin dinero. Null. The number halfway between -1 and 1. The only integer you can't put in the denominator. The odds of Trump not being an asshole.
Who runs the zoo?
There's a Board of Directors. It has powers...
The board shall have all powers and duties necessary to establish and implement Healthy California under this title. The program shall provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.
How does the spice flow?
Monies will flow from many sources (see below) into the Healthy California Trust Fund, which is administered by the Board. Money will flow out of the Fund for payment for health care. Multiple sources in, just one entity writing the checks (hence "single payer").
Insurance companies become shrunken shells of their former selves (and three cheers and a rah, rah! for that). They will only be able to provide coverage for things not covered by the legislation, like cosmetic surgery, and to people who are working in but not residents of California. Their CEO's will have to figure out other ways to earn their $10,000,000 annual salaries, and no one but them will shed a tear.
What does it pay for?
Covered health care benefits under the program include all medical care determined to be medically appropriate by the member's health care provider.
Condensing and abbreviating from the bill text, that includes but is not limited to:
- Health facility services
- Health and Mental Health care provider services
- Imaging, laboratory, diagnotic and evaluative services; dialysis
- Equipment, applicances, glasses, hearing aids, with repair and support.
- Blood and blood products
- Rehabilitative care
- Emergency care services and emergency transportation.
- Transportation costs for people with disabilities and those with low or no income
- Immunizations and prevention
- Health and Wellness Education
- Dental, Vision, Pediatric, Prenatal, Postnatal, Podiatric, and Chiropractic care.
- Prescription Drugs.
- Hospice, Skilled nursing, assisted living, home health and Adult day cae services
- Substance abuse treatment.
- Therapies that are shown by the National Institutes of Health, National Center for Complementary and Integrative Health to be safe and effective.
- Ancillary health care or social services previously covered by county integrated health and human services programs previously covered by a regional center for persons with developmental disabilities
- Health care and long-term supportive services currently covered under Medi-Cal or the state's Children's Health Insurance Program (CHIP).
- Language interpretation and translation for health care services, including sign language and Braille
- Case management and care coordination.
Phew! A better question might be “What isn’t covered?” That might turn out to be a significantly shorter list... Let's see:
- Chicken soup? No.
- Prayer healing sessions? No.
- Brain unwashing for Republicans? No, unfortunately, no.
- Death panels? No.
There you go. Much shorter.
What about my Kaiser membership?
What if you belong to Kaiser or a similarly structured, integrated insurance and health-care delivery system? That's covered. Kaiser and its sisters will no longer be delivering health insurance, just health and hospital care. Instead of collecting premiums from you and I they'll be charging the Healthy California Trust Fund.
If you belong to Kaiser you'll have three months to decided whether to continue with Kaiser or not. If you do choose to continue, my understanding is that you will be limited to using Kaiser's health care facilities, doctors and specialists, unlike everyone else who will be allowed to make an appointment with any health care provider in California. You'll have the choice again every year.
What if I'm on Medicare?
If everything goes according to plan, your choice of doctors just increased, and the amount you have to pay for Parts B and D just went down or away.
The board may take actions consistent with this article to enable the program to administer Medicare in California, and the program shall be a provider of supplemental insurance coverage (Medicare Part B) and shall provide premium assistance drug coverage under Medicare Part D for eligible members of the program.
Who's going to pay for it?
You. Me. And that person over there. Companies. The Feds. There's no free lunch (but your food will be free if you have to stay in the hospital!), and since we aren't going to convince dolphins or extraterrestrials to help, we're all we got.
Guess how much money spent on health care is public money already? According to analysis done by proponents, 70% of all California health care spending is already funded by public money. The idea is to "capture" all of it. Which leaves 30% to be covered - less what we ultimately save by going to a system which has neither insurance company overhead nor profit. That will be funded by some of the money corporations are already paying for their employees’ health care coverage and, if necessary, some kinds of taxes on We The People and Them the One Percent.
Taxes?!? You said "Taxes" ?!?
I know, I know. I just said a really bad word: Taxes. But, like, there's no premiums! No copays! No deductibles! No bills! No harassing phone calls about that $10,000 you owe for out of network services. No MediCal or Covered California applications. No more medical debt! Everybody's in, nobody's out! Hell, I don't know about you but I'd pay additional taxes for that. Take my money, please.
The bill's proponents are currently doing an economic study to figure out how much revenue will be needed to fund the system and where it should come from. The study results will be out in mid-May. Once that happens the funding mechanisms will be added to the bill. Right now what's in there is:
It is the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for the program...
Can California Really Do It?
California is one of the world's biggest economies. California has a bigger population and a significantly higher GDP per capita than two countries that have similar, working, straightforward single-payer systems: Canada and Taiwan. Of course we can do it - it just takes the political will.
Canadians love their system:
Most Canadians (85.2 percent) aged 15 years and older reported being 'very satisfied' or 'somewhat satisfied' with the way overall health care services were provided, unchanged from 2005.
And so do the Taiwanese:
Moreover, [the health care system] has been able to secure strong political support, with 80 percent of the Taiwanese population expressing satisfaction with their national health care.
Well, there's lots of stuff in the legislation about negotiations, care coordination, Taft-Hartley, Knox-Keene, standards, retirement systems, and the details of extracting the health care money from the Feds that currently makes its way to California. All the stuff you'd expect in a serious proposal to completely change how the financing and regulation of health care works. All the stuff you have no intention of reading and, honestly, unless your really wonky, very little reason to.
What's the status of the legislation?
It goes to the California Senate Health Committee on April 26th. The Campaign for a Healthy California in coalition with the California Nurses Association is holding a rally in Sacramento on that date.
What can I do right now to make this happen?
Senator Edward Hernandez is the chair of the Senate Health Committee. And he's a candidate for statewide office.
In 2016, Hernandez announced that he would run to replace Gavin Newsom as Lieutenant Governor in 2018.
You can call or write Senator Hernandez and tell him that there is no way in the opposite of heaven you will vote for him for Lt. Governor unless he votes for this legislation in his committee and on the floor of the Senate. That's what you can do right now.
State Capitol, Room 2080
Sacramento, CA 95814
Phone: (916) 651-4022
Fax: (916) 651-4922
West Covina District Office
100 S. Vincent Ave, Ste. 401
West Covina, CA 91790
Phone: (626) 430-2499