(Absolutely. Pushing a rushed reform compromise in two weeks would be a travesty, and it speaks to how deeply broken the legislative process is, because it creates all of these bottlenecks that, deliberately IMO, stifle debate. Sen. Kuehl makes a ton of sense here. However, I would be open to a special session to get something done if the process were made more open. – promoted by David Dayen)

Health Reform and the Year of Magical Thinking

The Year of Magical Thinking is the title of a memoir by Joan Didion detailing her state of denial, inexplicable behaviors and, finally, coming to grips with, the death of her husband. It’s also an apt description of the Governor’s 2007 approach to reforming our broken healthcare system, with the glaring difference that he still hasn’t come to grips with the truth. (After all, if a complicated movie plot could be resolved in less than two hours, who not fix healthcare in California in nine months?)

Beginning in January, the Governor ordered his health advisors to sketch the outlines of a plan that would magically “cover” all Californians by simply requiring them to buy health insurance.  To this moment, he has refused to negotiate any of his major points with the Legislature.  The language for his plan was finally drafted five months later, and shown, under wraps, to a few, select people.  Not one legislator agreed with it, and no one would carry the bill as legislation. 

More on the flip…

To fill the void raised by the Governor’s magical “we must do something this year” drumbeat, the Democratic leaders began crafting their own reform plan.  To date, however, the Governor and the Legislative leadership have remained oceans apart on the broad policy strokes of health care while public support for the current insurance-company controlled system has plummeted and support for the reforms contained in SB 840, the Medicare-like fix for California, has grown.

Now, with less than two weeks remaining in the first half of the two-year legislative session, there is still no “something” on the table and the Governor, like a Barnum and Bailey’s ring leader, continues to announce that he will, assuredly, pull a rabbit out of a black hat.  Actually, there is no way of knowing if the result would really be a rabbit; it could just as easily be an albatross. 

The Governor has further limited discussion by announcing that he would veto both of the legislative proposals that have actually been introduced as real bills. SB 840, by far the most carefully crafted, transparent and fully vetted bill, will remain in the Legislature until next year, since sending it down to him for a veto would end any consideration of single payer until 2009.  The individual mandate provisions in the Governor’s pronouncement are being emphatically rejected by virtually all stakeholders representing the people who would be forced to pay uncapped premiums.  The percentages to be paid by employers and individuals, hospitals and doctors, people in a “pool” and those outside, those above differing percentages of the poverty scale and those below, are so far apart in the Governor’s pronouncements and the Speaker’s bill, you could drive trucks through the gaps.  The Governor’s lynchpin financial mechanism of a provider tax remains submerged under the very murky water of a 2/3 vote.  What convoluted compromise might be devised in a last-minute attempt is anyone’s guess.

Nonetheless, we are told that, unless we agree to pass a yet-to-be hastily drafted bill that incidentally may be the biggest reform proposal ever attempted in health care, and pass it in two weeks, thus completely bypassing the entire political process and any semblance of open public input, we’ve completely failed and health reform is doomed forever.  Please.

The prospect of legislative staff, sitting behind closed doors, hastily crafting a 100-page health reform “compromise”, to be pushed through the legislature with little or no public input over the course of the next 14 days, is deeply irresponsible.  Frankly, given the example of the energy deregulation bill, we ought to know better.

Moreover, we lose nothing by taking advantage of the fact that the sessions of the California legislature are two year sessions.  Many of our major accomplishments, most recently, AB 32, the bill related to greenhouse gas, took more than one year to achieve.  Next year’s Presidential campaigns will ensure that health reform stays as the top of the agenda.  More importantly, the issue of health reform will continue to dominate because the people need it and want it.  What they want, and deserve, however, is responsible health reform, not a new debacle that benefits the health insurance companies the way the electricity bill benefited Enron.

Finally, we must not forget the reason that we are in this crisis to begin with.  Health care premiums changed by insurance companies continue to grow 3-4 times faster than wages.  A solution is needed that pays attention to adequate funding, affordability, cost controls and quality.

Even if the Legislature should pass a last minute convoluted experiment in health reform, there will still be a need to continue the work to enact a fully vetted, Medicare-like single payer system that replaces the insurance companies with a plan for all Californians, allows each person to choose their own providers, and protects affordability, comprehensive coverage and quality.  Such a solution is the only sensible and tested way to achieve universal health care responsibly.  Whatever happens in the next two weeks, the movement for single payer universal health care is continuing to grow, and SB 840 will continue as its focal point, the only legislation that establishes the kind of truly universal, modern and affordable health care system the people of California need and deserve.

(Thanks Sen. Kuehl! Keep on fighting! – promoted by Brian Leubitz)

The Budget Process Through July 21st

This is my third essay for 2007 and the first one I have done on the 2007-2008 budget, which has now passed, after a series of cuts and more cuts.  In this first of several essays on the budget, I will set out some of the provisions of the budget originally agreed to by the budget conference committee, the changes that were made to that budget in the Assembly in order to get 6 Republican votes and the reasons for the two-month stalemate in the Senate. Visit my website at www.sen.ca.gov/kuehl to read my previous essays. If you wish to subscribe to receive these essays on a continuing basis, (no charge), please send an e-mail to [email protected], titled “subscribe”.

Edits by Brian For form and space only. See the flip…

Budget Process, January to June

The Governor sends his proposed budget to the two houses of the Legislature in January, shortly after his “State of the State” speech.  It is immediately divided into four or five sections and given to the budget sub-committees in each house to analyze, critique, change and adopt, piece by piece.  Each administrative Agency and unit appears before a budget sub-committee to defend their budget.  In May, the Governor submits a revised budget, called the “May Revise”, based on adjusted (tax) income and expense figures for the current year and expected savings or increases. 

Hundreds, perhaps thousands, of individual line items are adopted in exactly the same language by the budget sub-committees in both houses of the legislature.  These provisions become a part of the budget without going to the budget Conference Committee for resolution, as none is needed.  Those items that are different in the Senate and Assembly versions of their budget sections are sent to the budget Conference Committee where the differences are ironed out and one budget is presented for adoption by both houses.

The Big Four or The Big Five

At the close of the Conference Committee, the closed door dealing among the leaders of both houses and the Governor begins.  This is often referred to as a meeting of the Big Five. Unlike previous governors, however, during the Schwarzenegger administration, the Governor is often absent from these deliberations and the four house leaders are left to try to iron out the differences and horse trade on their own.  This was the case with discussions on the bond package from last year and the prison “reform” package this year.  And it was the case with negotiations related to the Conference budget and cuts taken, as shown below, to get Republican votes on the budget in the Assembly on July 19th.

Why Do We Need Republican Votes on the Budget?

In California, Rhode Island and Arkansas, a 2/3 vote by each house of the state Legislature is required to adopt a budget.  In the other 47 states, only a majority is required, which means that the majority party is held to account for their budget and their priorities, and the voters judge them on those priorities.  In California, the budget is generally held hostage by the minority party (I was in the minority in my first two years in the Assembly), because the budget vote is the only issue the minority can truly affect.

The Conference Budget Before Changes by the Big Four

The Budget put forward by the Conference Committee was already a lean and mean budget in many ways.  It was leaner than the Governor’s May Revision proposal, but managed to reject the Governor’s proposed cuts to CalWorks kids only grants, retained a cost of living increase for the poorest CalWorks working recipients, (however, putting that increase off for six months), and retained funding for the homeless mentally ill the Governor had wanted to cut.  In addition, the Conference budget moved $500,000,000 worth of transit money to the general fund, in order to fill some of the “structural deficit”: the difference between revenues and expenditures.  The reserve was a healthy one: about two billion, approximately what the Governor had in his budget.  The revenue assumption included a $4.8 billion fund balance brought over from last year’s budget, $102.3 billion in revenues and $103 billion in expenditures. The final General Fund reserve in the Conference Budget was projected at $3.4 billion. 

Additional cuts and tax credits added by Assembly

The Budget, as originally passed by the Assembly, reflected even deeper cuts, including deleting all funding for CalWORKs cost-of-living adjustments; providing no General Fund help to cover student fee increases at UC and CSU; delaying, from January to June, the state portion of the SSI/SSP cost-of-living adjustment; reducing funding for Proposition 36; and increasing the monies shifted from public transit to the General Fund to a total of $1.2 billion. 

The budget, as passed by the Assembly and sent over to the Senate on July 19, provided full funding for growth and a cost of living adjustment for K-12 education but did not create new programs, rejected the Governor’s bid to cut $314 million in CalWORKs that would have penalized children and families seeking to become self-sufficient, invested in a 5 percent rate increase for foster family homes, restored $26 million in academic preparation programs at UC and CSU, and included $1.6 billion to fully fund Proposition 42 (transportation). (This is different from the projects that would have been funded by the gas tax revenues shifted into the general fund and referred to, above.)

The Assembly Vote on the Budget

This year, the Assembly voted on the Budget before the Senate, in one marathon session on Thursday night, July 19th.  The Republicans in the Assembly held out for a number of changes until 4:30 in the morning, when they negotiated a $500,000,000 tax credit package in a separate bill, sent the budget to the Senate and left town.

The Senate’s Deliberations on the Budget

Perhaps “deliberations is not quite the right word.  The budget and all the trailer bills (except the amazing tax credit package, which had come out of nowhere) were put up for a vote the next day, Friday, July 20th.  Each budget vote garnered 25 Democrats for, 14 Republicans against and one abstaining.  27 votes are required to adopt the budget and the trailer bills.  The bills were put “on Call” while President pro Temps Perata attempted to get two Republicans to vote.  Throughout the next 23 hours, as all Senators remained on the Floor of the Senate (trying to sleep, if at all, in their chairs or taking turns on the couches), the Republican caucus made their demands clear: they would not vote for a budget unless another $700,000,000 was cut from the budget in order that revenues and expenses would zero out.  Even though there is a very healthy reserve, that was not sufficient.  At 10am Saturday morning, July 21, we were adjourned, with no budget and no budging by the Republicans.

Next…..

Senator Perata told minority leader Senator Ackerman that morning that if his Republican caucus were simply continuing to say “no”, they needed to come up with their own budget, one that clearly showed the cuts they wanted to make.  On Wednesday, July 25th, with the Senate again in session, the Republicans failed to present a budget, but had given the press a list of cuts they would like to make to “balance” the budget, including eliminating the subsistence CalWorks payment made to children whose parents have been unable to find work and have “timed out” of CalWorks, or for children of undocumented parents. The demands also included transferring the 200 million left in the gas tax transportation account that had not already been swept into the budget, into the General Fund, leaving several current transportation projects without funding; exempting certain construction projects from the California Environmental Quality Act relating to greenhouse gas emissions; and attempting to add parental consent for reproductive services for minors in the budget, which the electorate of California has turned down twice.

The next day, Senator Ackerman indicated he did not want the Republican budget to be heard on the floor because even his caucus was divided on it.  The Governor was unable to secure the two Republican votes needed to pass the budget in the Senate.  Republican Senators refused to meet with the Governor and, as the days passed, instead of working on a compromise, the Republican caucus simply increased their demands, cheerfully indicating that they were dedicated to holding out until the Assembly returns into session so they could reopen the entire budget.

No Budget…No Money

For state services, for hospitals, for K-12 education, for community colleges.

See the next essay for the resolution, such as it is, to the budget stalemate.

( – promoted by Robert in Monterey)

California Speaks:  We Want Single Payer
by Senator Sheila Kuehl

On August 11th, 2007, at the culminating and boisterous OneCareNow rally in Los Angeles, as well as eight coordinated “listening” events around the state, sponsored by Blue Shield and the California Endowment, among others, a random selection of thousands of Californians spoke out overwhelmingly in favor of major health care reform.

At the largest rally of the year, more than two thousand advocates, patients, nurses, doctors and universal health care fans gathered on the steps and lawns of the Los Angeles City Hall to excoriate a health care system that does nothing but devastate working families with systematic cancellations, denials and delays in care.  This doesn’t promote health, it isn’t care, and it certainly isn’t a “system”– it’s traumatizing and often deadly for people who thought they would be given care, but, instead, got nothing but a tangle of insurance red tape. 

Convinced that single-payer universal health care is the only hope for fixing our broken health care system, they gathered to support SB 840 (Kuehl), the only truly universal health care plan proposed in legislation that is shown to contain costs, improve health care quality and allow Californians total choice of their doctors and hospitals.

Perhaps by design, on that same Saturday, health care foundations (including Blue Shield Foundation, Kaiser Family Foundation and the California Endowment) spent over $4 million on an event originally spun as an exercise in “deliberative democracy”, but in reality was carefully structured to control discussion, in order to ask randomly selected participants to discuss and “vote” on their preferences for healthcare reform.

Naming the event CaliforniaSpeaks, organizers claimed the event would bring together thousands of Californians to discuss their perspectives on the current health reform proposals still under debate in Sacramento, yet the agenda was careful to exclude single payer from the discussion.  Organizers of the event told us the reason that they didn’t include single payer was because the governor said he wouldn’t sign it.

Apparently when they said the event was designed to give Californians the chance to set the health care agenda, what they actually meant was that the event would be an opportunity for the people to jump in line with the Governor’s healthcare agenda.  As is often the case, the people had a different idea-they did, in fact, jump; they jumped out of their seats demanding that single payer and SB 840 be included in the discussion, forcing the organizers to tack the issue on at the last minute at the end of the day.

The fact that participants were forced, on their own accord, to demand the inclusion of single payer at the CaliforniaSpeaks events clearly indicates that the conventional political message, mostly propagated by the health insurance companies, has yet to understand that two decades worth of traumatized patients and families, along with an even higher consciousness of our failings set out in Michael Moore’s new film, “SiCKO”, has changed health reform politics forever. 

Consider the overwhelming standing ovation that Steve Skvara received (http://www.youtube.c…) at last Tuesday’s Democratic Presidential Debate when he asked, chocking back tears, “What’s wrong with America?”, describing how his family lost their guaranteed retiree health coverage when the company who owed it to him filed for bankruptcy.  Skvara’s story immediately resonated with millions of Americans across the nation, and he became an instant online celebrity.  Why?  Because he clearly illustrated our broken health care system and the abuses of corporate greed.  Skavara’s story is one of thousands that are positioned to spark the simmering anger that a broad spectrum of Americans feel toward our insurance based non-system. 

California families are becoming so hurt and so incensed at insurance company greed and abuse that they are increasingly willing, like nurse Cynthia Campbell’s husband, to pick up a megaphone and plead “Don’t Kill My Wife” in front of Blue Shield’s headquarters.  And the transformation crosses the political spectrum.  Art DeWerk, the Police Chief for the central valley town of Ceres, spoke out recently in favor of single payer as he described the helplessness he felt after his wife was unable to get timely access to routine medical care as she battled cancer.

These and other stories are found all too often in a health care system where the only competition is between insurance companies focused only on how much risk they can avoid, instead of the more appropriate competition between direct health care providers for quality service, driven by a single payer system that allows total patient choice of doctors and hospitals. And stories like those set out above, as well as others, even worse, will continue until we ditch the “system” that spends 30% of every health care dollar simply to weed out those of us who are sick enough to need our coverage and move to a real universal healthcare system that eliminates the middleman and returns decision making in healthcare to doctors and patients.

By the end of Saturday’s “listening” event, after everyone had discussed the intricacies of the incremental plans, single payer surprised the organizers by polling better than the others, with significantly more people saying they would support it under any condition.  For those who supported a generic single payer system, but with conditions, SB 840 was, in fact, the only plan that actually met all the conditions set out by the discussants.  For example, 53% of the participants statewide said they would support single payer if they could choose their own doctors and hospitals.  SB 840 guarantees this.  In contrast, both mandates which define the Governor’s policy paper and the Speaker of the Assembly’s bill, AB 8, received support by the discussants only if there were caps on costs and premiums.  In fact, neither proposal currently includes this provision.

Both the rally in Los Angeles and CaliforniaSpeaks showed us that the people of California are way ahead of the Governor, as well as the Speaker, with regard to healthcare.  At the end of the day, more participants felt that quality of care shouldn’t depend on how much money you have, that everyone should have access, and that greed should be kept out of the health care system.

Interestingly, and perhaps tellingly, later that same day, the Governor was quoted on a Fresno news station as saying he would sign SB 840 “as soon as we have the money for it”.  Of course, the Lewin Report, studying the factors set out in the bill, has already shown how the plan will be funded.  But, whether the Governor’s pronouncement signals a serious shift in his thinking, it certainly acknowledges the political momentum that SB 840 has garnered.  I welcome the conversation on funding, because we’ve got the money.  SB 840 can easily be achieved with our current health care spending, personal, employer and state and federal.  It would use the money wasted by the insurance companies on denying care to provide it, to all Californians, without co-pays or deductibles, for one affordable premium each year.  What we need is the political will to catch up with the will of the people of California.