( – 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.

The big news out of Sacramento this week, aside from the worsening budget situation, is movement on health care reform. As was liveblogged here yesterday, Sheila Kuehl’s Senate subcommittee held a public hearing and vote on AB 8, the less ambitious effort to reform health care by bringing more people into private insurance. As that hearing revealed, one of the most common statements from groups offering conditional support was that cost containment was a necessity – without it the bill was worthless, and many of the groups present would come out in opposition to it.

Cost containment is the key to AB 8. It’s the devil that lurks in the details. It’s worth a further look, if we are to believe that AB 8 is something that we who support real health care reform should help with our time and effort.

The basic problem with health care in America is that it is controlled by private insurers. In order to make massive profits, they have a clear interest in driving up the cost of premiums while at the same time denying or limiting what they pay out in actual coverage. Health care costs wind up bankrupting households and forcing businesses to either shed jobs, cut coverage (thereby hurting themselves through loss of work days due to greater frequency of illness), or close / leave the state.

As I noted back in February, universal mandate plans such as those offered by Arnold or by Mitt Romney fail because they force individuals to pay exorbitant costs with little care in return. For AB 8 to be a positive step for California, it would need to be able to bring California workers and businesses good coverage without leaving them vulnerable to soaring premiums or copays or deductibles.

Hence the focus on “cost containment” in so many of the comments yesterday. Unless there is language in AB 8 limiting costs, it could very well backfire badly on California workers and businesses, saddling them with soaring costs to help line the pockets of Blue Cross and their ilk.

So what exactly are the prospects for strong cost containment measures in AB 8? Depending on who you talk to, they’re unclear at best, dim at worst.

As Anthony Wright noted in his excellent review of yesterday’s committee meeting, Speaker Núñez actually rejected the best cost containment amendments:

Nunez said he could not, at this time, accept the committee suggestion — which consumer groups supported — that total health care costs (including premiums, deductibles and other out-of-pocket costs) be limited to 5 percent of a family’s income. Right now, under AB8, only families in the purchasing pool under 300% of poverty ($62,000 for a family of four annually) are guaranteed to not have to pay more than 5% on just their premium….Nunez also did not accept amendments that would have established minimum package of benefits for private group coverage, with regard to preventative care and cost sharing. AB8 does have a basic HMO benefit (Knox/Keene and prescription drugs) in the purchasing pool. Nunez responded that AB8 does establish three standardized products in the overall private market, to help consumers better make comparisons between plans, allowing for “apples to apples” comparisons.

As Wright noted, Núñez’ explanation for the lack of a cap on costs for all consumers was that, while he “would love nothing more” than to achieve that, there was simply not enough money available to guarantee it. Given the Republican obstinacy on the budget that makes sense – but it does also raise the question of just how useful AB 8 will actually be, especially to middle class households that make more than 300% of the poverty line but who are squeezed by rising housing and other living costs.

Jerry Flanagan, of the Foundation for Taxpayer and Consumer Rights, is less enthused about how AB 8 is shaping up. In a column today on the California Progress Report Flanagan argues that as it stands now, AB 8 is no better than the individual mandate plan Arnold proposed at the beginning of the year.  He provides damning stats on how donations from HMOs to Democrats Leland Yee and Gloria Negrete-McLeod may have led them to refuse to vote on cost containment measures in a separate but related bill, AB 1554, preventing its passage (he also provides excellent stats on how Republican legislators have also benefited from HMO cash). Combined with the failure of strong cost containment amendments to AB 8 itself, this suggests that the California Nurses Association may have been correct when they argued AB 8 was no better than Arnold’s own plan.

AB 1554 is not totally dead, it can be reconsidered before the end of the 2008 session. And the amendment process for AB 8 is by no means complete. But given the pragmatic realities of this year’s budget and the resultant inability of Speaker Núñez to embrace effective cost containment language, AB 8 may not be the good, stopgap solution to tide us over until we can get single-payer accomplished that many have claimed it to be. It might in fact make the present situation even worse, as it leaves open the possibility that insurers will be able to stick workers and businesses with dramatic cost increases and worsening levels of care.

Ultimately this situation shows the need to be assertive and bold in planning health care reform in California. The current political system, averse to taxes, hostage to an obstructionist Republican minority, in thrall to large corporate contributors, and unresponsive to the needs of Californians, is what has brought about the health care crisis. That system cannot be expected to produce useful reforms all on its own, no matter the good intentions of someone like Speaker Núñez.

That doesn’t mean we’re screwed. It instead reminds us that our approach has to be holistic – that we need changes in the way California politics operates if we are to revive the fortunes of progressive Democrats and finally start addressing the problems facing Californians. It’s a truth we’ve all known for some time now.

And it finally suggests that AB 8 isn’t any more or less pragmatic than SB 840 – they both seem to encounter similar obstacles, even as SB 840 is the clearly superior solution. Clearly a lot of work has to be done in California before we can get any meaningful health care reform. Why not mobilize, then, behind single-payer, and work to shorten the distance between it and its ultimate passage, than fighting over a flawed bill such as AB 8?

(I love me some liveblogging. Just so everyone is clear: SB 840 is Keuhl’s single payer bill and AB 8 is the Nunez/Perata bill that stays within the private insurance model. – promoted by juls)

Things are about to get underway as It’s OUR Healthcare! will be liveblogging from the John L. Burton Hearing Room where the Senate Health Committee chaired by SB 840 author, State Senator Sheila Kuehl (D-Santa Monica), will meet at 1:30pm.

Senator Kuehl is setting the ground rules for the hearing. (No cheering, clapping or booing.)

Scheduled to speak are the Speaker of the Assembly Fabian Nunez (D-Los Angeles) and Senate President Pro Tem Don Perata (D-Oakland).

Check for updates below the fold.

Speaker Nunez has just arrived and will start the discussion on AB 8. Senate Pro Tem seated right beside him.

In front of Senator Kuehl is a white sign with black text: “DO NO HARM.”

Speaker Nunez says that he and Perata are pleased to be here to make a major step in ailing a system that is broken.

Nunez: [Kuehl] You are a champion of healthcare for all Californians.

Nunez: AB 8 built on the idea of shared responsibility between employers, government and individuals. These measures will not fix the entire healthcare market, but improve it. This is a rare opportunity to fundamentally improve our healthcare system. We need to act now; take advantage of this opportunity.

Nunez: All of the uninsured children in California will be covered by this legislation. It will move 3.4 million (of the 6.5 million) under coverage.

Nunez: This is not a perfect plan, but will help pave the way for “real healthcare reform.”

Senator Perata now at the podium.

Perata: “[Bills merged because] we got tired talking to each other. We wanted to talk to the Governor.” Says we should have a national healthcare program. “Scandalous” that the U.S. is “woeful” on healthcare. California must provide the leadership [for the country].

Kuehl: In MA, they just added “affordable” to the name.

Witness: (Speaking of SB 840 support) “It seems like Kuehl’s gang were all over the place.” Kuehl replied jokingly, “Kuehl’s angels, we call them,” and the room chuckled.

Angie Wei, California Labor Fed acknowledged the huge number of IOH supporters that have traveled from across the state today. Provisions supported: Creation of statewide purchasing pool; establishment minimum of healthcare spending requirement; subsidies and discounts for families below 300% poverty level.

Concerns: issue of cost containment (union members have been able to hold on to their healthcare but pay a dear price for that; early retirees face risk of losing their healthcare; current system is unsustainable); affordability (we need to protect families from maximum exposure out of pocket).

Beth Capell, Health Access California: [Legislators] have been receiving healthcare Stories of the Day. Retells her own personal healthcare story involving her husband. “Never once did we worry we whether we could pay for his care. It should be that way for everyone.”

Number of studies released today on employer-based coverage. AB 8 would have a modest, yet positive, impact on California’s economy and not cost jobs.

Capell: We can do something this year that will improve the economy and help with people’s care.

Witness: AB 8 would improve healthcare for low-income Californians.

Mary Hernandez, SEIU: We support AB 8 if amended to control healthcare costs.

Gary Passmore, Congress of California Seniors: Add amendments on two issues for support; truly a work in progress; “we like what we see”

Consumers Union: support if amended; transparency a must;

AFSCME: We want to make sure this bill includes cost controls.

California Medical Association: support if amended; refinement of cost control efforts; inclusion of fiscal transparency

CNA voiced opposition to AB 8, instead favoring SB 840.

Senator Sam Aanestad (R-Grass Valley) suggested to the Speaker that he work with the chair, put a hold on the bill and work on it through the fall.

Kuehl: “I don’t like your bill as much as I like my bill.” (The assembled crowd laughed.)

Kuehl: If we had the right Governor, we’d have it (SB 840). But my responsibility, is to now. Responsibility to push as hard as I can to hammer on the issues at hand. I am going to support this bill today (AB 8). It must keep moving to have a vehicle better than the Governor’s plan.

Nunez: Your bill (SB 840) is not only a bill that I not only support, but enthusiastically support. AB 8 is not perfect but will help a lot of people — 3.4 million.

Kuehl voted in favor of AB 8, vote is currently still open.