(This is my personal opinion on the subject, others may differ. The Governor’s proposal is so expansive and desperate to be liked that there’s something for everyone to praise and denounce. – promoted by dday)

OK, I think I’ve read every possible news report about the Governor’s health care proposal, and I’m still confused.  Why exactly is this called “universal care”?  It doesn’t ensure that everybody is covered, it demands it.  That’s not universal care, that’s a universal threat.  And while I agree with Ezra Klein that even single-payer health care is a universal mandate in that it uses required taxes to fund health care, applying that mandate without cutting down costs for consumers makes this a fantasy, as Ezra explains.  On the flip…

The question with an individual mandate is subsidization and affordability. If we pass a law levying an individual mandate and subsidizing premiums down to $50 a month, there’ll be few complaints. A mandate with no subsidization, however, is an impossible burden on millions of families. When evaluating an individual mandate, that’s where liberals need to focus: The generosity of the subsidies. The Wyden Plan, for instance, subsidizes up to 400 percent of the poverty line. The Massachusetts plan subsidizes up to 300 percent. The Schwarzenegger plan subsidizes up to 250 percent. That looks too low, and I’ll talk more about it later today.

I look forward to seeing that, Ezra is very good on this issue.

This plan is very reflective of the Governor’s newest persona as a post-partisan.  What makes it ultimately unsatisfying and potentially dangerous is that it lacks the same thing the Governor lacks: core beliefs.  Instead of trying to jerry-rig all of these different ways to find the money so that everyone in the state has a low, vague level of health care (if I read this right, under this plan my premiums would go up and my coverage would go down), why not step back and try to lay out what the end goals are?  I believe that health care is a right and not a privilege.  I believe the money spent on health care today is enough to fund a successful, robust system where people get quality care, doctors and hospitals make money, and the public at large is generally healthier.  If that was the goal, you wouldn’t continue to perpetuate this myth that employers have an obligation to make sure their employees are healthy.  On this score I completely agree with the LA Times editorial board:

The problem is this: It makes no sense to legally and permanently make Californians’ access to healthcare dependent on their employers. Companies hire workers and pay them for their time, talent, muscle and brains. Employers must meet certain standards to do business in the state – complying with workplace safety laws, paying the minimum wage, providing workers’ compensation insurance, etc. But they should not become the primary mechanism for the state to deliver vital services to citizens.

This is more true here than elsewhere because so many Californians who need insurance have only marginal or temporary relationships with employers. Companies, meanwhile, face plenty of challenges just staying in business and keeping up with the dynamics of the modern marketplace without being saddled with a new health insurance tax.

What ends up happening, and would still happen, is that people would stay in dead-end jobs because of their health insurance, because the subsidies wouldn’t be big enough to justify the poor care and the cost of going it alone.  And American companies are less competitive because they stand alone in bearing the burden of health care.  And taxing companies who opt out of paying for employee health care by 4% of profits is a pittance compared to actual health care costs for companies.  You’ll end up with a de facto state-run health care system with no possibility to rein in costs.  The cost-containment strategies, mainly HSAs and telling people to join a gym, are laughable.  Employers can’t provide health care and compete in a global marketplace, and the state cannot fund health care without keeping costs down.  The plan does neither.

(Never mind the fact that a key point of funding this mish-mash is by taking $2 billion out of the public health system.  The funding aspect of this is almost totally ridiculous.)

Another core belief of mine is that no plan should keep in place and largely intact the for-profit insurance system which, through greed and dirty dealing, benefits from its own stinginess in denying care and trying to eliminate the sick from their rolls.  The Governor’s plan would be the greatest thing ever to happen to the private insurance industry.  It would give them four or five million new consumers, who they would be required to provide with care.  That’s a positive step, but it does nothing to contain costs for those consumers based on age or occupation.  Insurance companies can jack up rates that Californians MUST pay.  How’s that for a license to print money? 

The CNA has a very good roundup of this plan which I urge you to read.  And I’m pleased with the reaction of Art Pulaski of CalFed.

“While the Governor’s healthcare proposal includes some positive elements, it is the wrong prescription for California’s health care crisis. This proposal will be a boon to insurance companies, but a bust for most workers. This plan requires all Californians to buy health insurance with no guarantee that it will be affordable or that coverage will be adequate. We are concerned that the plan creates an incentive for employers who currently provide health care to drop coverage and instead pay only a minimal tax.”

That’s it in a nutshell.  And I really hope that Democrats in the Legislature, who were very nearly effusive in their praise of this strategy, wake up and figure this one out.  Perata and Nuñez are pretty much alone in their support.  Is this tactical?  If so, it’s the worst tactical maneuver I’ve ever seen, and calls into question what their goals for health care really are.  It doesn’t seem to be changing a broken system.  It doesn’t seem to be making health care affordable for everyone.  It doesn’t seem to be doing anything but making insurance companies rich.

This is a very Republican program in that it puts the risk and burden of health care, largely, on individuals.  Just like moving pensions to defined contributions from defined benefits, just like proposals to privatize Social Security instead of keeping it protected, just like “free trade” causes job insecurity for the vast amount of America’s workers, the message to individuals is simple: YOYO.  You’re On Your Own.  That’s what this proposal is for Californians. 

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.