In Shum’s diary she referenced a post from Avedon Carol that I thought was a great way to understand the current health-care debate in California, and would provide a valuable lesson for Democrats in the state.  I’d like to highlight it.

Many of us have been talking about the need for Democrats to start high before going to the bargaining table. This is not a radical new idea – everyone knows that when you dicker for a good price, you don’t start with the “reasonable”, “compromise” figure.

But Democrats seem to have lost the idea of haggling. If they want single-payer healthcare, they ask for single-payer healthcare. (Or worse, they do what the Clintons did and try to offer the insurance companies something, which kills the whole idea.) If they want a minimum wage of $7.25, they ask for a minimum wage of $7.25 […]

I want single-payer to pass, but I think single-payer would sound much more reasonable if there were people out there demanding a fully-socialized healthcare program like Britain’s NHS (as Nye Bevan designed it, not the anemic thing successive governments have been turning it into). Go all-out: Demand an NHS, and single-payer will sound nice and capitalist and moderate – as it is.

Avedon is absolutely correct.  You don’t give up the battle before it is even joined.  If politics is the art of compromise, then compromising BEFORE you reach the bargaining table is a guarantee that you won’t be able to get anything near wht you really want.

Especially when the opposition is ALREADY bargaining into your position, albeit with fits and starts.  On the flip…

The governor has proposed covering all children, including those in the state illegally by circumstance (the number of which seems to be either consequential or not, depending on who you ask).  It’s cheap to cover children and immoral not to.  As a starting point, I’d take this plan over the Massachusetts Mandate plan any day of the week.  But, what’s important here is, as Kevin Drum notes,

Details are murky so far, but I don’t think the mechanics of Schwarzenegger’s plan is what’s important anyway. What’s important is that two of the Republican Party’s highest-profile governors have now publicly endorsed the idea of universal health coverage for their states. In other words, some kind of universal, or semi-universal, healthcare has now been established as the rightmost bound of the healthcare debate.

Democrats should understand what this means: (a) universal healthcare is no longer some lefty fringe notion, and (b) the plans from Schwarzenegger and Massachussetts’ Mitt Romney are now the starting point for any serious healthcare proposal. Any proposal coming out of a Democratic policy shop should be, at a minimum, considerably more ambitious than what’s on offer from these two Republicans.

It’s important to understand who’s under pressure to deliver on health care.  The public knows that we pay more for health care in America and receive less.  They are almost unanimous in supporting governmental solutions to providing access to affordable health care.  And the governor has made health care his signature issue for 2007.  It was a big part of today’s coronation, and it’ll be a major part of next week’s State of the State.

If health care reform doesn’t happen in 2007, the governor will be blamed.  Bottom line.  And understanding this, he’s already moving toward a position that Democrats in the legislature can accept, with universal coverage for children.  In fact, this is to the LEFT of Don Perata’s proposal which excluded illegals.

It’s absurd, as Drum says, for Democrats to do anything but push for something far beyond an on-the-margin proposal out of the box.  Yet this is exactly what Perata and Fabian Nuñez have done, claiming that they were putting something together that the governor could accept.  This belies a fundamental misunderstanding of the art of the deal.  If you believe that health care is a right and not a privilege, you start from the position of covering everybody in the state, and then compromise.  As it stands now, the middle of this debate would include HSAs and partial employer mandates, and essentially a reaffirming of the private insurance system that’s making everybody sick to their stomachs.

Business, which has a firm grip on the legislative joystick, hits the panic button at talk of single-payer healthcare or universal healthcare, and it hauls out its own boogeyman phrases, such as “job-killer” and “drag on the economy.”

I’ll tell you what’s a drag on the economy. Healthcare insurance that’s impossibly expensive, or impossible to get. If the United States wants a vital economy of personal enterprise and risk-taking, then it needs to guarantee health coverage, period. Americans are willing to take chances in business and careers, but not with their families’ health, or their own.

Dan Luke is an Oregon insurance broker. He told me that he runs into this “all the time – people staying in jobs they don’t like. People have dreams about going into business for themselves that they can’t fulfill because they don’t want to lose medical coverage, and they can’t pay a lot of money for [individual policies] even if they are healthy.”

I gave him a professional for instance: Say there’s a man who wants to switch careers, start something on his own. He’s 59, married, four kids, comes to you for health insurance. He smokes cigars. (“Mmmmm,” I heard Luke say.) And he had heart-valve surgery almost 10 years ago.

Luke stopped me right there. The man would never get coverage. I didn’t even get to ask Luke about the risk factors of riding motorcycles and skiing.

My “for instance” is Arnold Schwarzenegger. If the governor weren’t a rich man, if he were just a guy with a bold idea who wanted to give it a shot, as Schwarzenegger did when he abandoned acting for governing, he couldn’t get health insurance. He’d be stuck in his old job instead of bringing something new to the economy and to his life.

That should be the philosophy guiding any baseline proposal on fixing health care.  Otherwise there’s no need for the Democrats to come to the bargaining table at all.  They might as well let the governor write the policy.  It’s time to figure out the haggle and try to get something the people want, rather than what they wrongly believe is politically possible.

cross-posted from Working Californains

All of the major news papers seem to have different details that may or may not be in Arnold’s health care proposal.  There are two proposals that come directly from a one pager the governor’s office released yesterday.  The rest are rumored leaks.  We could wait until he gives his speech Monday at 11 am to figure it all out, but why wait?  Let’s see if we can sort through this, shall we.

Confirmed

• Employers would be required to offer health savings accounts, otherwise known as Section 125 plans.  The plans let workers save pre-tax dollars to pay for premiums of individual insurance.  This is also part of Nunez’s plan.  From Health Access’s Anthony Wright:
  

  Similar to a provision of the Massachusetts plan, this would require employers to facilitate (but not fund) Section 125 plans, thus giving workers the ability to save up to 40% of their premium. While this would not help most uninsured who still would find buying insurance as individuals unaffordable, it will help more Californians take advantage of federal tax breaks.

• Safeway inspired reward system for insured persons to take pro-active steps to improve their health.  Think “health-related goods” (gym memberships etc) for those who lose weight, stop smoking, and keep chronic diseases under control.  Wright again:
  

  While the governor is careful to say that people who don’t engage in “healthy action plans” will not be penalized, some advocates were concerned with the focus on “personal responsibility” rather than systemic solutions for healthier living.

• Coverage for all California’s children, including those here illegally.  Price tag: about $380 million to cover 750,000 uninsured children.  The proposal would raise “the eligibility threshold for the state’s Healthy Families Program to 300 percent of the federal poverty level, or $60,000 for a family of four.”

Not Officially Confirmed

• Shifting of governmental dollars from reimbursing health care providers for indigent care to directly pay for insurance for a portion of that population.  The total may be “up to $2 billion in tax money.”
• Provider tax:  Currently doctors, hospitals, dentists etc charge the insured a premium to make up for treating those without insurance.  “As more people become insured, costs are reduced, and those savings can be redirected to other parts of the health care system.”

These are all relatively small pieces to the larger puzzle.  There is nothing here that directly addresses how we will reduce the high number of the uninsured who are poor.  Health savings plans will not cut it.

Covering all children is relatively inexpensive.  That is the only new piece of spending that has leaked out.  Despite its relatively small cost, it will face strong opposition from the Republican caucus.  In the end, we should be able to control the debate.  Republicans will not look good in the public eye by trying to deny health care to children.  They should not be punished for things out of their control.

(Another installment of the Total Recall series. Good work Erik. – promoted by SFBrianCL)

By Erik Love – From The Courage Campaign 

The first installment of Total Recall, the Courage Campaign Governor Watch, focused on perhaps the most pressing issue facing California — health care.  The objective of Total Recall is simple: see whether the Governor fulfills his campaign promises.  Yesterday's LA Times had on its front page a story about early details of Governor Schwarzenegger's latest plan for providing insurance to some of the 6.5 million people in our state without any health coverage.  The plan would provide coverage to nearly all of the children living in California — an important achievement to be sure.  But the Governor's proposal is most surprising because it would include undocumented children in its coverage — a proposal which seems to be at odds with Schwarzenegger's conservative base.  While an official announcement of the Governor's plan will appear next week, it appears that the administration has allowed a trial balloon to hit the papers to gauge reaction to this most controversial aspect of his proposal.

If the Governor's plan remains true to the details seen in yesterday's newspaper article, then progressives will find much to like.  Insuring California's children would be an important, big step forward.  Still, it's important to remember that such a plan would only be the beginning.  Schwarzenegger promised to extend health insurance to as many Californians as possible.  Schwarzenegger's plan to insure children would affect about 760,000 people — still leaving about 6 million Californians with no health insurance.  The pressure would still be on the Governor to finish the job.

Moreover, while the Governor would be lauded for including all children in California in his plan, it will be difficult to forget Schwarzenegger's previous anti-immigration statements, including his now infamous "Close the Border!" speeches.  And, it's important not to forget that the Governor had an excellent, financially sound plan for universal health care on his desk as recently as August 2006.  Despite his insistence that insuring Californians is a priority, Schwarzenegger vetoed that plan because it wasn't politically advantageous for him during his reelection campaign.

Now that health care appears politically advantageous, Schwarzenegger is ready for a bold proposal.  This is good for the hundreds of thousands of children in need of health insurance, unquestionably.  But Schwarzenegger still has a long way to go to prove that he's more than a political opportunist on this issue.  Total Recall will be there when the Governor's health care plan is officially unveiled next week.

First for the meta: I have a new part-time gig blogging for Working Californians.  Like Todd does here for the Courage Campaigns expect a few cross-posts from me each week over here and at MyDD/dkos.

So what is Working Californians?  Well..here is my first post from yesterday.

You can read more about the WC mission here but, in short, WC is a strategic research and advocacy non-profit focused on quality-of-life issues for working people in LA and California. The co-chairs are Brian D’Arcy and Marvin Kropke, who deserve a lot of credit for thinking about the long-term and investing in strategic research and advocacy. Also, Working Californians was the main independent expenditure campaign that helped elect John Chiang as State Controller last year.)

Let’s kick start the discussion with today’s LAT piece on strategic research memo written by Working Californians’ strategists, using quantitative and qualitative research (ie, polling and focus groups) that Working Californians did in LA last fall. LA Times reporter wrote about it in yesterday’s paper.

Los Angeles unions enjoy a decided “brand advantage” over corporations among city voters, and the labor movement should use that popularity to advance “union-led solutions” to key public policy issues in 2007, a memo written by top labor strategists says.

The two-page memo, which was obtained by The Times, argues for broader, more straightforward engagement on policy issues than many unions have undertaken in the past. Some labor leaders prefer to focus on their own contract issues, and even those who are active in politics often soft-pedal the “union” label.

The document demonstrates labor’s confidence as it heads into a new year of big battles over politics, contracts and organizing.

The bottom line is that unions are a trusted communicator for LA voters and we can use that to advocate effectively on behalf of the working men and women in California.

“There is a significant opportunity for organized labor in Los Angeles,” the memo says. “In particular, we’d highlight these factors: unions’ fundamentally positive image and ‘brand advantage’ over business corporations; the overlap between union priorities and the key concerns of voters across the electorate in L.A., and the opportunity to expand public understanding of the connection between local government and the full range of quality-of-life issues.”

Public support for unions in LA is growing, and that presents a great opportunity for the effectiveness of labor sponsored advocacy campaigns.

Binder’s poll found that unions have more public support in Los Angeles than in other areas of the state and country. Among city voters surveyed, 55% agreed that “without unions, there would be no middle-class left in America.”

Reflecting the labor movement’s influence in city politics, the memo argues for talking up local government’s ability to deal with issues such as the economy, healthcare and the environment, which generally are considered federal and state matters.

The memo calls “for a public education campaign focused on union-led solutions to the quality-of-life issues that Los Angeles voters regard as most important.” The memo suggests that such a campaign be conducted before 2008, when state and national election campaigns will probably consume union energy.

“Los Angeles, against its own history, is a labor town now,” said Cherry, one of the strategists, who was a key figure in the successful effort to defeat Gov. Arnold Schwarzenegger’s slate of ballot initiatives in 2005. “One of the things that comes through in the poll is that people really see the potential of unions to take up the cause of ordinary people on quality-of-life issues.”

That is at the heart of what we do at Working Californians.  Labor campaigns do not just lift up union members, but all those working men and women that are at the heart of what makes California great.  Without a vibrant union movement and solutions to high housing costs, health care, transportation, the environment and other quality of life issues, people will continue to leave this state in droves.  We cannot afford to squeeze out our middle class.

(Shum is the type you want to have in a foxhole with you and CNA rocks! – promoted by blogswarm)

The California Nurses Assocation/National Nurses Organizing Committee will spend 2007 organizing for John Conyers’ “Medicare for All” bill, and Sheily Kuehl’s California Health Insurance Reliability Act.  Thesd kinds of single-payer healthcare plans are the only affordable, just way to provide a single standard of high quality care to all people.

We’re developing our internal blog; below is today’s news on the fight.

LOS ANGELES TIMES-Superstar columnist Patt Morrison notes the problem at the heart of today’s broken health-care system: insurance corporations.  America wastes hundreds of billions of dollars a year to subsidize a private insurance industry that does little but create a middleman between patients and care providers, while frittering away care dollars on marketing, profits, and bureaucrats AND denying coverage to customers it doesn’t like.  Take it away, Patt: 

Business, which has a firm grip on the legislative joystick, hits the panic button at talk of single-payer healthcare or universal healthcare, and it hauls out its own boogeyman phrases, such as “job-killer” and “drag on the economy.”

I’ll tell you what’s a drag on the economy. Healthcare insurance that’s impossibly expensive, or impossible to get. If the United States wants a vital economy of personal enterprise and risk-taking, then it needs to guarantee health coverage, period. Americans are willing to take chances in business and careers, but not with their families’ health, or their own.

She notes that Arnold Schwarzenegger-a 59 year-old cigar smoker-would find it impossible to buy health insurance for himself.

ABC NEWS- Finds great news on the battle for single-payer healthcare.  Rep. Barney Frank, incoming chair of the House Financial Services Committee, will offer the business community a “grand bargain” that includes single-payer healthcare and extension of unionization rights in exchange for pro-business policies on trade, immigration and direct foreign investment.

LOS ANGELES TIMES and SACRAMENTO BEE-Governor Arnold Schwarzenegger today begins a PR blitz for the Monday announcement of his healthcare reform plans.  He had promised “universal” health care, but is dialing that back to just include more coverage of the state’s children.  What about adults and seniors?

The LA Times reports that his plan for securing health insurance of the state’s 763,000 children would cost approximately $400 million, and the Sacramento Bee reports it will apparently be run through a state program known as Healthy Families.  While details of the plan for adults and seniors of his plan remain sketchy, it appears to fall into the “much more of the same” category-extending business-based coverage through private insurers, perhaps with an individual mandate that criminalizes those who don’t purchase insurance.  This is a recipe for continuing the trend of declining quality and exploding healthcare costs, while leaving significant portions of the population without coverage or access to the quality care they need.

NEW YORK TIMES- Governor Eliot Spitzer is proposing legislation that would expand Medicaid and state children’s insurance to cover more New York residents.  Like Schwarzenegger, Spitzer is choosing a “nibbling around the edges” approach that does not resolve the fundamental and tragic problems in our healthcare system that are leading so many of us to pain, heartbreak, financial ruin, and early death.

SAN FRANCISCO CHRONICLE-Reports that 8 out of 10 state residents want the government to assure health coverage.  Do the politicians know this?

THE HEALTHCARE BLOG-Carries an interesting proposal for a partial single-payer system, combining Medicaid, the public health systems and other institutions into a National Health Service for the Uninsured, which could serve as a model for a national health program.

NEW ENGLAND JOURNAL OF MEDICINE- Overviews the Democratic agenda on healthcare.  They’ll start with the feel-good stuff-prescription-drug pricing and embryonic-stem-cell research.  It’s not clear where they go after that. 

  BLACK COMMENTATOR- I just found this excellent article from a couple of months ago in which Marilyn Clement lays out “A Strategy for seeking a national-single payer healthcare system that will cover everyone in the United States.”

x-posted on Ruck Pad

Following up on my post from last night… What a shocker.  They passed out tickets to the special interest dinner based on the donation amount.  Those companies who donated the most, get to bring more lobbyists to have some private time with Arnold’s staff.

The governor’s accident may disappoint donors who hoped to see him today at an exclusive “sponsor’s reception.” Political aides had sent out invitations offering potential donors a certain number of tickets to the closed-door reception based on the amount they contributed to defray the cost of the inaugural festivities.

“Gold” sponsors, who kicked in at least $50,000 each, were offered 10 tickets. “Silver” sponsors who gave at least $15,000 were offered two tickets to the reception. Those who gave $50,000 include Chevron, the California Chamber of Commerce, and the California Real Estate Political Action Committee.

Oh Julie, do you actually believe your own spin?

The governor’s office said it shouldn’t bother donors that the headliner is bowing out.

“Those who contribute to the governor do so because they believe in his vision for the future of California,” said Julie Soderlund, Schwarzenegger’s spokeswoman.

“Whether he’s at a reception or not doesn’t change the fundamental fact that these individuals have contributed because they want to celebrate the governor’s second term,” Soderlund said.

These people wanted to celebrate the governor’s second term by cementing their influence with him.  They got one more chance to remind him that they have invested in him and that they expect something back.  They have another opportunity to get face time with the administration that millions of other Californians could never dream of getting.  There is no such thing as a free lunch and Californians will pay the price for Arnold’s need to party.