Note: The following is a response, written by Jeanine Meyer Rodriguez of SEIU’s California State Council, to Sen. Shiela Kuehl’s 7th essay on healthcare reform posted on the California Progress Report titled “The Speaker’s and Governor’s Healthcare Bill: Part of a Series of Essays by Sheila Kuehl.” I work for It’s Our Healthcare, which is a coalition that includes SEIU.  However this response should not be taken to be representative of any other member of the IOH coalition or the coalition as a whole.  This is SEIU’s position.

Senator Kuehl’s essay is full of criticism but makes no mention of a politically viable solution.  Single payer is not going to happen just because it is good policy: we need a strategy for winning. But single payer can evolve if we start with the right framework and keep working on it.  In the meantime, millions of people without adequate health insurance go without care when they are sick and some die because of it.

Medicare and Social Security are not perfect programs but they are better today than when they were created. AB1x is not a perfect bill but it is far better than the status quo today-and we can make it even better over time.

On the substance, there are lots of problems with how the Senator characterizes the bill.  I’d like to highlight just a couple of the main points.

[More on the flip]

“Provisions of the bill actually harmful to regular, working and middle-class families…”

* The status quo is harmful to regular, working and middle-class families as our healthcare rapidly deteriorates. There are protections in the bill to ensure that the mandate is not “harmful” to working and middle-class families.

* For the first time ever sets a standard for health benefits on the job: today employers can and do drop coverage. Just as the minimum wage sets a standard for wages that helps working families, so will setting a standard for health benefits on the job.

“nothing is provided.”

* Public program coverage is provided to millions of Californians, including 800,000 children and over 2 million adults. Many others would be provided subsidies to get coverage.

“no regulation of the cost of insurance or medical expense, no maximum deductibles, and no floor on how little coverage you can buy…”

* An estimated 3-4 million people would get coverage through a statewide purchasing pool-twice the size of CALPERS–which would be able to negotiate for the best possible price.

* Now, for the first time, this bill gives a state regulator authority to set maximum deductibles and a floor on benefits that insurers can’t go below.  Junk coverage is sold right now and hundreds of thousands of people find only when it is too late that they bought junk.

The Senator’s comments about SEIU are offensive and just plain wrong.  We have been focused on healthcare reform for many years now and have been working hard to make real progress.  SEIU’s change in leadership of the State Council did not change our position on healthcare reform. If we are salivating at anything, it is at the prospect of getting health coverage for 70%-80% of the uninsured.

SEIU locals in California have remained united all year in support of our principles for healthcare reform and we continue to stand together.  We are fighting for our members’ interests and for their families too.  Our families want what all Californians want–affordable, real healthcare when we need it.

It’s time to come together to make something work because the status quo is not acceptable and we can’t afford to wait any longer.

Update: AB 8 Passed the Senate and the Assembly

(Note: I work for the It’s Our Healthcare Coalition which includes member organizations in support of both SB 840 and AB 8).

This morning, Assembly Speaker Fabian Nunez and Senate Pro Tem Don Perata held a press conference about AB 8. 

They were joined by supporters of AB 8 such as Count Dracula, the CEOs of all of the major health insurance companies in California, the honorary co-chair of the Schwarzenegger for Senate 2010 committee, and a bunch of people who like to drown kittens. Oh wait, that’s not what happened at all. 

Yet that’s what you might have expected given the rhetoric coming from some quarters. The rhetoric has gotten well beyond ridiculous, and it’s time to stop engaging in bizarre fantasies and the shrill invective and start talking seriously about the healthcare reform debate in California. 

When it comes to debating the merits of AB 8 and SB 840, it’s easy to bash insurance companies and  it’s easy to believe that politicos are about to sell us out on something so vitally important.  But none of that deals with the fact that large elements of the progressive movement are supportive of AB 8 for very legitimate reasons. 

Reasonable people can disagree.  Nobody is compelled to support AB 8.  But to ignore these stakeholder groups and their legitimate interests in seeing healthcare reform this year (much less to demonize them as some have done) is not only bad politics, it’s wrong.

[More on the jump]

First, let’s look at some of the groups who have come out in support of AB 8:

• The California Labor Federation
• SEIU
• AFSCME
• the Unitarian Universalist Legislative Ministry of California
• AARP-California
• California ACORN
• the Latino Coalition for a Healthy California
• Congress of California of Seniors
• AFTRA
• Health Access California

They’re not exactly the Legion of Doom. 

Were AB 8 to pass, it would represent the single largest expansion in health coverage in decades.  It would extend coverage to literally millions of Californians. AB 8 would cover approximately 70% of the uninsured, a tremendous increase over SB 2 (passed in 2003), which would have covered approximately 20% of the uninsured had it not been repealed via referendum (Prop 72) in 2004. 

There is no denying that AB 8 is not universal healthcare.  But there is nobody who is seriously arguing that true universal healthcare, much less single-payer healthcare, will be signed into law in California this legislative session. 

And so those who argue that we ought to withhold support for AB 8 in favor of waiting for something better (e.g. SB 840) are actually saying that it is better to continue to allow people to suffer now and take the risk that nothing substantial will happen for years instead of helping those we can in the interim.

For the 4.9 more than three million Californians who would get coverage under AB 8, the issues are real and urgent, and asking them to wait even another year is asking them to endure the risk of incalculable harm: bankruptcy, preventable sickness and death, harm to themselves and their loved ones.  It is fine to argue that AB 8 does not represent a complete solution to the healthcare problems we face, and I would agree with that.  But absent a strong argument (one that shoulders the burden of proof) it’s simply callous to ask that others be martyred and denied protection based on some abstract political calculation. 

And make no mistake about it, a political calculation is what undergirds all of the arguments against AB 8 from those who will not tolerate anything less than a jump from the status quo to a single-payer system in one fell swoop. 

There is no reason that I have seen offered by supporters of SB 840 to oppose AB 8 in its current form except that a) AB 8 putatively helps the insurance companies by expanding health insurance coverage to more people and b) passage of something now might stymie a change to a universal or a single-payer system. 

THE MOMENTUM ARGUMENT

First, let’s deal with the issue of momentum.  Opponents of AB 8 like the California Nurse’s Association have (amazingly) pointed to the enactment of Medicare as an example of gradualism gone awry, thereby killing momentum for fundamental reform.  RoseAnn DeMaro, the Executive Director of the California Nurses Association, in an article with the inflammatory title of Whose
Life Doesn’t Count? writes:

With public frustration over the collapse of our healthcare system mounting, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, also provides one of the best arguments against incremental steps. When Medicare was enacted 40 years ago many contended that the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

 

You follow that logic?  Medicare is “our most successful national health program,” which demonstrates that we ought not to take incremental steps like…the enactment of Medicare.

We know we can help millions of people now. We don’t know whether it is even possible, much less likely, that we will be able to enact more meaningful reform in the next couple of years.  I don’t think that this means we pack up and settle for something short of a solution.  But taking one affirmative step towards a solution does not mean that you can’t take another step later on.  Does anyone really think that enacting Medicare seriously made us worse off? Would any progressive, if they could go back in time, argue against its enactment because of our current situation? Bueller? Bueller? 

THE ROLE OF INSURANCE COMPANIES ARGUMENT

Anyone who’s concerned about the role of insurance companies in our healthcare system would be perverse to oppose AB 8. Here’s why: AB 8 substantially reforms the role of insurers in our healthcare. It sets a floor for the percentage of premium dollars that must be spent on healthcare (85%). It creates a public insurer to change the playing field and guarantee that there’s real competition with low overhead and driving the market in the right direction. Finally, it bans denial of insurance for pre-existing conditions and actually requires health insurance plans to help fund a real, adequately-funded, high-risk pool.

Many of the things we hate about insurance companies are now completely and utterly legal.  It boggles my mind that anyone who supports single-payer healthcare wouldn’t, while we still have the current system, want insurance companies to be better regulated.