(Tragically, the girl in question, Nataline Sarkisyan, died yesterday evening after this diary was posted. nyceve at Daily Kos has more about the netroots’ role in forcing CIGNA to capitulate. – promoted by Robert in Monterey)

I am pasting a release below about the Dec. 20 “Patient’s Revolt” that forced heartless CIGNA corporation to approve the liver transplant that could save the life of 17-year-old Nataline Sarkysian.

It’s been an emotional day involving hundreds of people, but there are a couple of lessons I want to take away.

First–we have power.  We shouldn’t be afraid to use it.  A unique coalition of the California Nurses Association/National Nurses Organizing Committee, a union, together with netroots and the Armenian Community shamed a global insurance corporation into doing the right thing.

Second–we shouldn’t have to do this…and every candidate pushing to mandate individuals purchase insurance products from the likes of CIGNA, who would still be in the business of profiting through the denial of care, should think long and hard.  Are the CIGNA’s of the world really the people who should control our healthcare dollars?

Here is the full release.  Highlights:

CIGNA CAPITULATES TO PATIENT REVOLT

Following Massive Protest, Insurer Authorizes

Transplant for 17-year-old Nataline Sarkysian

CNA/NNOC-Sponsored Protest Sparks Flood of Calls from Across U.S.

In a stunning turn-around, insurance giant Cigna has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkysian, a 17-year-old girl in the intensive care unit at UCLA Medical Center.

A national web of friends and family of Nataline, CNA/NNOC registered nurses, doctors, members of the Armenian community, healthcare advocates and netroots supporters pitched in on an unprecedented national day of action on Nataline’s belief.  

The centerpiece of the protests was an impassioned rally today sponsored by CNA/NNOC with the substantial help of the local Armenian community that drew 150 people to the Glendale offices of Cigna. Hundreds of phone callers clogged the lines of Cigna offices around the country, all demanding that Cigna reverse its prior denial of care.  

“This is an incredible turnaround generated by a massive outpouring around the country that proves that an enraged public can make a difference and achieve results,” said CNA/NNOC Executive Director Rose Ann DeMoro. “Cigna had to back down in the face of a mobilized network of patient advocates and healthcare activists who would not take no for an answer.”

The netroot protest was organized by Eve Gittelson an influential health policy blogger who writes on Daily Kos as nyceve, and many of the calls were also the product of work by the Armenian National Committee.

“Natalie is now seriously ill and still has significant hurdles in her fight for her life, but thankfully our combined voices and protests have finally given her and her family hope,” said Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center.

“However, it is deplorable and appalling that CIGNA needed to have hundreds of people pounding on their doors and besieging them with calls to take the humanitarian step they should have done long before today,” said Jenkins who spoke at the Glendale rally.

Nataline’s mother, Hilda Sarkisyan, expressed her profound thanks to CNA/NNOC. “We couldn’t have done this without you helping us to stand up against this insurance company and forcing them to finally do the right thing. It is not right in this country for it to take a rally, a protest, and a major press conference to get an insurance company to listen.”

“Every politician who thinks the answer to our healthcare crisis is more insurance should stop and think about Nataline Sarkysian,” said DeMoro. “Insurance is not care. Paying for insurance coverage is not the same as assuring you will receive appropriate care, even when recommended by a physician as it was for Nataline. Insurance corporations profit by denying care to the sick, and that is no way to run a humane healthcare system.”

DeMoro said that CNA/NNOC will continue to encourage patient protests and publicize stories about insurance companies’ denial of care, as it has all year through its www.guaranteedhealthcare.org web site, while pressing for real healthcare reform “that takes medical decisions out of the hands of insurers and places them where they belong, in the hands of healthcare professionals and their families.”

I thought this was the key moment in the Appropriations Committee debate over ABx1 1, which passed the Assembly yesterday.

Republican Assemblywoman Mimi Walters asked Nunez and the Department of Finance whether they were certain financial projections would come through. AB x1 1 relies on $4.5 billion in federal dollars in addition to other revenue sources. Department of Finance staffer Tom Sheehy said one provision in ABx1 1 would not be implemented unless the Director of Finance declared that money to pay for the program was in hand and in state coffers.

Assemblyman Mark Leno, Democrat chairman of the Appropriations committee, followed up with questions about whether the program could be turned off if money did not come in as expected. Nunez’ staff responded that ballot initiative would contain provisions to assure that insufficient funds would trigger a series of events to pull back the program, including the individual mandate and the market reforms. It would first allow the governor and legislature to fix any fiscal imbalances. If lawmakers and the governor did not act, then the pieces of the legislation would be repealed, including the public program expansions and tax credits, returning the state to the status quo.

This is the key because this is what has happened to every single state that has tried to implement anything approaching universal health care.  They pass the bills with a lot of fanfare but are either unable to control costs or keep up with population or their numbers on revenue fall short (nobody EXPECTED the $14 billion dollar budget deficit this year, to use a parallel example), and the program has to be scaled back and eventually scrapped.  And there’s no massive celebration or gathering on that day, where everyone gets in a room and congratulates each other.  But that’s what’s happened very single time.

The bill has some advances on the health reform front, and is not an ignoble effort.  But nobody seems to want to deal with these historical facts.  “This is better than nothing” doesn’t mean anything when 5-7 years down the road, you’re ACTUALLY left with nothing.  And I think walling off the funding and claiming that it’s revenue neutral makes it more likely that road will be travelled again.  The state budget should reflect priorities.  We all want every Californian to have access to health care.  Paying for it with part gimmick taxes, part wishes and hopes of federal support, et cetera, shows that you really don’t value it all that much.  And admitting that the program will fall apart unless people continue smoking a lot of cigarettes… well, you see where I’m headed.

UPDATE: Ezra Klein, the sharpest commentator on health care in the progressive blogosphere, on the plan:

It is, in short, a pretty good plan — better, in certain ways, than those offered by the national Democrats — and it’s got the support of folks ranging from the Democratic legislature to Arnold Schwarzenegger to Andy Stern. I’m not super confident in its long-term prospects, as various groups are going to spend hundreds of millions to defeat the ballot initiative containing its financing package, and even if the plan survives that, I still don’t believe states have the fiscal strength to sustain universal health care in times of recession. But I’d like to see it pass, if only for the momentum it would give the national conversation over health reform.

Klein doesn’t get back to his native California much, so I can forgive him for later plaudits in the post about Schwarzenegger.  But I definitely associate with the remarks I’ve bolded.

UPDATE II: Shorter Sen. Perata: Fuhgettaboutit.

“I think it’s DOA. I haven’t found anybody yet that I have talked to that can make any sense out of it. It sounds ridiculous to say that we’re going to have health care for everybody in four years, but in the meantime most people won’t have health care because we have to cut the budget,” Perata told KPIX.

On Monday, the Senate leader sent a letter to the nonpartisan legislative analyst asking what the fiscal impact of the health plan would be on California’s budget deficit.

“You couldn’t balance your home checkbook that way, much less run the fifth or sixth largest economy in the world,” Perata continued in the interview.

Then he ended with this: “He simply does not understand the way in which this works,” though it’s not clear from the clip who the Oakland Democrat is referring to.

Arnold Schwarzenegger and Fabian Nuñez have made agreements behind closed doors on a new $14 billion dollar health care plan, and despite the fact that we’re on the brink of a fiscal emergency, even though Don Perata has favored a go-slow approach, asking to deal with the burgeoning budget deficit before a new health package, it appears that we’re going to have a vote in the Assembly on Monday.  And that has displeased some key stakeholders.

Assembly Speaker Fabian Nuñez’s effort to speed a healthcare overhaul plan through the Legislature is being opposed by the trade group that represents California’s labor unions, which is taking the rare step of urging Democratic legislators to defy their own leader.

In a letter obtained Saturday, the California Labor Federation’s leader, Art Pulaski, urged Assembly members to postpone the Monday vote on the bill, which Nuñez (D-Los Angeles) submitted Friday after reaching agreements with Gov. Arnold Schwarzenegger on the scope of a plan to require almost all Californians to hold healthcare insurance.

Writing that “we are dismayed at the process,” Pulaski complained that neither labor nor lawmakers had had enough time to vet the complex measure and decide whether it offered adequate protections against middle-class workers’ being forced to purchase insurance policies they could not afford.

“We feel cheated of the opportunity to take a position on a bill that will impact the lives of every working family in California,” Pulaski wrote. “We do not know whether this bill will protect working families who cannot afford a healthcare mandate or whether families will be driven into low-quality, high-deductible plans.”

So we have a bill submitted on a Friday which lawmakers are expected to vote coming Monday.  It’s 239 pages long and completely unclear, not just on affordability for the insurance itself, but on the floor for basic coverage and the ceiling for deductible costs.  Health care experts have not fully made that determination.  Add onto that the struggles of states to manage large-scale universal plans with their particular constraints, mainly on constitutionally mandated balanced budgets.  We are in a $14 billion dollar budget hole and with a Governor itching to balance that on the backs of poor and elderly Californians with a 10% across-the-board budget cut.  There simply aren’t all that many areas you can cut that aren’t protected by voter initiatives other than those in the health and human services sector.  Does that factor in to this parallel plan at all?  Not to mention the fact that so much of the funding option is predicated on federal funding at a time when the Democrats can’t get SCHIP past the President’s veto pen, which will result in tens of thousands of California children being denied coverage within a matter of weeks.

Despite all of these questions and concerns, the Assembly is being asked to rush through legislation that they probably haven’t read or vetted.  I think health care is simply too important to do so.

If we are ever going to get genuine healthcare reform, we need to make sure politicians listen to nurses-not insurance companies-on the issue.  

That’s why the all the energy among activist nurses around the country are such good news.

We’ll take a look at what’s up below …cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model

Starting in Nevada, RNs at St. Mary’s in Reno voted overwhelmingly to join the California Nurses Association/National Nurses Organizing Committee.  Go read that incredible story.  Joining CNA/NNOC will give these RNs, at long last, a statewide voice in pushing for guaranteed, single-payer healthcare, which is vital for Nevada.  It also helps CNA/NNOC continue its rapid national expansion, which gives us the ability to do this.

In our home state of California, 5000 RNs are striking today and tomorrow against the troubled healthcare giant Sutter, which is infamous for short-staffing its units, thereby endangering patients.  Fights for a safe ratio of nurses to patients is a key part of the larger fight for healthcare reform; in essence what it does is guarantee a minimum level of care for patients within hospitals.  (Along with an earlier strike in October against Sutter, these are the largest nurses’ strikes this nation has seen in a decade.)

Finally, great news for the movement for guaranteed, single-payer healthcare: Colorado has become the 29th state labor federation to endorse John Conyers’ HR 676 “Medicare for All” bill.  The labor movement is coalescing around single-payer healthcare, meaning it is the only reform proposal with an organized, motivated grassroots base working for its passage.  Who really gets excited by the idea of forcing every person to purchase expensive, wasteful insurance products from the very corporations who brought you the healthcare crisis?

While politicians debate individual mandates-a/k/a forcing Americans to purchase expensive, unworkable insurance products from the very corporations who brought you our healthcare disaster-more evidence rolls in about how Americans are being bankrupted by their health insurance.

…cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model.

Remember as you look at these stories that the big insurance companies take one-third of care dollars off the top, for profits, lobbying, CEO salaries, bureaucracy and overhead.  Medicare, America’s single-payer system, by contrast takes 3% off the top for all that.  Not even the mafia takes a third.

A new report today finds that in the last year health insurance costs rose ten percent.  Yes, that’s higher than the rate of medical inflation-meaning insurers are grabbing and keeping more money for themselves.  Imagine the financial impact if insurers can mandate those double-digit annual rises on every single patient, not just the ones they now cover.

The Wall St. Journal (sub. req’d) looks at Americans who get sick, and then go bankrupt when they bump up against their insurance caps.  Think you’re covered?  Think again!

The Journal cited a study, the Commonwealth Fund Biennial Health Insurance Survey, report that that 26% of Americans with health insurance had trouble paying medical bills in 2005 alone.  What did they do?

39% used up all their savings

28% covered it with credit cards

26% were unable to pay for basic necessities

11% took out a second mortgage or a loan

And THIS is the answer to our health care crisis?

From Iowa to California to Massachusetts, the national healthcare debates are finally starting to hit the key point: the problem of the health insurance corporations.  We’ll take a look below…cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model.

The key issue is being played out now on the Presidential campaign, in exchanges between Sens. Clinton and Obama.

Clinton (and Edwards, Romney, Schwarzenegger, etc.) supports the individual mandate, requiring every person to carry health insurance, most likely purchased from one of the huge insurance corporations that have been busily gutting out health care system for their own profits.  Obama is put into a difficult spot by charges that he doesn’t support “universal” care, but argues that the reason people don’t carry insurance is because they can’t afford-not, usually, that they don’t want it. 

Of course, both sides are ignoring the key point: every other industrialized democracy is successfully operating some version of a single-payer system; only we put insurance companies ahead of public health needs.  Nonetheless, it’s important to decide if we want to hand over more customers, influence, adn revenues to the same insurance corporations that are speedily wrecking our health care system.

Out in California, Schwarzenegger and the legislature is considering their own mandates, cheered on lustily by insurance donors greedy for more profits.  One key problem? 

public health officials who provide most of the care for millions of uninsured residents are increasingly concerned that the proposed system could leave big financial holes in the state’s safety net.

Which only makes sense…if you channel billions in public subsidies to insurance corporations, and guarantee their profits, of course the public health systems take a huge financial hit.  That’s where the money comes from. 

The good news for Californians?  A deeply-divided state government might just make this harmful “reform” impossible to pass.

Meanwhile, kids in California are about to start getting dropped from the public rolls, while the politicians debate their plan for insurance company subsidies.  Unvelievable.

Massachusetts is starting to experience the problems with its own mandate experiment.  Short answer: only people who get subsidized insurance are signing up, while the insurance corporations are gleefully jacking up rates 10 to 12 per cent a year on everyone else. 

Finally did you catch NYCEve taking on the NYT editorial board?  Wow.

The Wall St. Journal reports on the new marketing plans for the health insurance companies: push health care reform, reap $100 billion in annual public subsidies!

We’ll take a look at that, as well as the GOP candidates who don’t care about cancer, the Sacramento insiders letting kids’ health fail run out, and new problems with the “Massachusetts mandate” law.

…cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model.

It’s like the insurance companies wrote the law themselves.  Across the country, “healthcare reform” proposals are moving forward that would leave the current broken healthcare system intact, protect the role of the insurers, AND give them tens of billions of dollars in new revenues from government funds?

Democratic presidential candidates like to beat up on insurance companies, but there is a lot for the industry to like in their health-care plans — starting with plenty of new business.

“Here’s the potential for a whole new pool of lives for them to cover, with payment behind it,” said Benjamin Isgur, assistant director of PricewaterhouseCoopers’ Health Research Institute, which examined the presidential health plans’ impact on industry. The study, a comprehensive look at health-care plans offered by candidates in both parties, also concludes that doctors, hospitals and other health-care providers would likely benefit since more patients with insurance suggest more would seek care and be able to pay their bills.

The leading Democratic candidates all propose boosting spending — by around $100 billion a year — mostly to help people buy private insurance plans.

Of course the insurance corporations are not dumb:

The early signals from the insurance industry, which played a major roll in killing health-care reform in 1994, are positive. The industry’s chief lobbyist, Karen Ignagni, president of America’s Health Insurance Plans, says she is encouraged by the debate so far and says her group is focused on trying to get universal insurance enacted rather than stopping it. “At 20,000 or 30,000 feet, we have heard encouraging statements from Democrats and Republicans,” she says.

Meanwhile, the same “individual mandate” law in Massachusetts is good for insurers, but blowing a hole in the state budget.  And that hole is not fixable, since there is simply not enough public money to give protect the massive profits of the health insurance corporations.

GOP candidates who have survived cancer seem to show no compassion for other cancer survivors, at least if you trust their healthcare plans, and Sacramento insiders are showing precious little compassion for kids in that state who are about to get tossed off the healthcare rolls.

Zenei Cortez, RN, has been a working bedside nurse for 30 years and is a member of the Council of Presidents of National Nurses Organizing Committee and California Nurses Association…and we’re quite proud to say she’s the first Filipino to hold that office.

She takes on the Schwarzenegger-inspired healthcare deal in today’s San Francisco Chronicle with an oped called, “Hasty Health Care Deal Not Ready for Prime Time.”

While reading her words, remember the experience that Registered Nurses across this country share: every day they watch patients *with* health insurance go broke, and get sick because they can’t afford the medical treatment they are allegedly covered for.  This is a key reason RNs oppose health care “reform” built on padding forcing more patients into the arms of the insurers who messed things up in the first place.

…cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model.

In addition to providing the insurance companies with *BILLIONS* of dollars in new public subsidies and forced payouts from working- and middle-class patients, the proposed deal suffers from the following problems:

It’s equally evident what the deal won’t include:
— Limits – other than a vague reliance on the market which created the mess – on skyrocketing insurance premiums, deductibles, co-pays, hospital charges, doctor’s bills and other fees that are rising at double, triple or more the rate of inflation and increases in worker’s wages.
— Choice of doctor, hospital or other provider. Unlike Medicare, insurers or employers will continue to be able to restrict patients to their medical plan’s network or require costly additional payments to see other providers.
— An end to insurance industry control over basic decisions about your health. Insurers will still be able to block referrals to specialists, deny needed medical tests or access to the newest prescription drugs, and can still refuse to pay for care deemed “experimental” or “not medically necessary,” even when it is recommended by your doctor. 

And if you’ve been reading that you’ll be protected from runaway costs?  Uh…

The cost protections are a mirage. Many middle-income families will qualify for state tax credits to help pay for the insurance they are required to buy. But a tax credit hardly makes up for costly monthly premium payments and other fees.
Further, the proposed annual out-of-pocket limit of 6.5 percent in costs applies only to the barebones mandatory policy. Anyone seeking coverage that includes such essentials as dental, vision, mental health, long-term care, and other needed care will have to pay much more.
The likely result will be more consumer debt for medical bills; a great boon for the banks and credit-card companies but increased financial risk for Californians and an encouragement to self-ration needed care due to the prohibitive cost.

And we’re not the only ones who see the obvious comparisons with energy de-reg….remember that was supported by just about every lobbyist in Sacramento, especially those with ties to Enron:

A decade ago, there was also a consensus for energy deregulation. The result was blackouts, higher costs for consumers, a financial calamity for the state, and open thievery by Enron and other energy corporations.
We should learn from that experience. Rather than rush through an ill-conceived plan that primarily rewards the same insurance giants, let’s adopt a more commonsense step, expand children’s health coverage with federal funds now and get real, guaranteed health care reform done next year.

(Game on, I suppose. – promoted by Bob Brigham)

I hate to be melodramatic, but that’s pretty much what it comes down to.

At least according to today’s report finding that America is last among industrialized democracies in terms of infant mortality.  Because our healthcare system is set up to guarantee billions of dollars of profit to unnecessary insurance corporations, kids born here are more likely to die than they are in countries with guaranteed healthcare through the single-payer model.

…cross-posted at the National Nurses Organizing Committee/California Nurses Association’s Breakroom Blog, as we organize for GUARANTEED healthcare on the single-payer model.

One place this hits hard is Memphis, along with other cities with predominantly African-American populations.  African-American kids are two and a half times more likely than white kids to die in infancy.  Racism starts early, I guess.

This is the context in which Rudy Giuliani stated his big lie about cancer patients being better of in America than Europe.  He’s been proven wrong but refuses to apologize.  Kids are being killed on a daily basis by this system and he refuses to admit it because it doesn’t square with his bid for President.  Ezra Klein takes a look.

One of the real flashpoints for the battle over healthcare is in Kentucky and West Virginia, where nurses across the country are traveling to support their striking colleagues in the Appalachian Regional Healthcare System.  ARH is trying to bump up their profits by slashing the number of nurses caring for patients.  Profits over patients indeed.

In California, we’re working hard to stop a fake reform plan that includes an individual mandate, e.g. a requirement that every person purchase expensive, wasteful insurance products.  Fortunately, public opinion is turning against this nasty little brew cooked up by Arnold Schwarzenegger.  If we can break it here, we can break it anywhere!

(Apologies to the Thers at Whiskey Fire for stealing his gimmick of using a Guided By Voices lyric as a blog title)

I feel like there are two completely different conversations happening on the major issues of the day in California.  In one, there is an historic opportunity to provide quality health care to everyone in the state, which will be affordable and comprehensive and go a long way toward solving our numerous health care problems.  In the other, the state is completely in the fucking toilet and nobody in a position of power has the political will to do anything about it.

Now the governor finds himself in a predicament similar to that of his predecessor, Democrat Gray Davis: staring at a crippling budget shortfall that threatens to overshadow all other business in the Capitol and tarnish his political legacy.

On Monday, Schwarzenegger ordered all state agencies to prepare plans to cut spending across the board by 10% next year. Education, transportation and healthcare will all be affected. Some programs face elimination. Layoffs may loom. The state’s budget shortfall, thanks largely to the troubled housing market, has ballooned from a few billion dollars projected at the beginning of the year to $10 billion.

Experts are not surprised.

“There has been lots of talk and lots of gimmicks, but none of the state’s underlying budget problems have been dealt with,” said Ryan Ratcliff, an economist at the UCLA Anderson Forecast. “Even in the middle of a revenue boom, we kept spending more than we take in.”

Spending has increased, but the issue is structural.  There’s no way California can meet the needs of its burgeoning population under the draconian revenue and spending structure we have in place, and the Governor has made no moves to fundamentally change that, just to pass the horror show on to whoever replaces him in the most hacktastic manner possible.  Here’s Kevin Drum.

Four years ago Arnold Schwarzenegger took office in the midst of a massive budget crisis after promising voters that he would end our “crazy deficit spending.” In true Republican fashion, he did this by immediately reducing the state auto licensing fee by $4 billion a year and then insisting that we all approve $15 billion in bonds to paper over a shortfall that was now even more desperate than the one he inherited. The hope, apparently, was that nothing bad would ever happen to the economy and eventually we’d squeeze out from under the rock we were under.

I opposed the bonds at the time, and I’ve never regretted that vote since. Defeating the bonds would have caused immense fiscal pain, but it would also have forced Schwarzenegger and the legislature to actually fix our underlying problem by increasing taxes and reducing spending. Our nonpartisan legislative analyst made it clear from the beginning that Arnold’s plan had no long-term chance of success, but he just flashed that million-dollar smile and went ahead with it anyway.

And now we’ll be paying for years and years to come, with ENORMOUS pain just down the road when the bonds come due.  And we’re talking about providing universal health care?

The plan itself has significant things to feel good about, even if it is only a first step.  It includes an individual mandate, but with all of the affordability exemptions, it’s not a mandate at all.  It expands public health services as much as any reform since the creation of Medicare and Medicaid.  And there are excellent reforms like guaranteed issue and a modified community rating for cost control.  Obviously there are questions about what minimum coverage provides but the affordability requirements, capping out of pocket costs at 6.5% of income, should be a mitigating factor.

But the entire discussion is happening in some kind of alternate universe of fiscal health.  The 10% across the board cuts will impact health care, particularly any public care options; is AB X1 going to account for that?  The convoluted funding mechanism, which will need voter approval because the 2/3 system for tax increases is still in effect, includes 8 core parts, including “federal matching funds” and “reinvested state savings.”  Why don’t you just add a pony, too?  We’re heading into a time where the state could be as much as $10 billion in the hole.  The new entitlements will be the first ones crowded out by a governor wedded to anti-tax ideology.  And he hasn’t signed on to a new cigarette tax, by the way, still preferring PRIVATIZING THE LOTTERY, and the net income increase from which will be approximately zero dollars in the long term, at best.

And let’s not gloss over the ballot-box hurdle such a plan would have to scale.  Maviglio soft-sells the defeat of a tobacco tax to pay for health care in Oregon yesterday, saying that California’s different, conveniently forgetting that Prop. 86, which was, um, A TOBACCO TAX TO PAY FOR HEALTH CARE, failed miserably here just last year.  In fact, the Oregon ballot measure wasn’t the only one that a tax-averse, skittish electorate rejected yesterday.

Cost-conscious voters rejected school vouchers for Utah students, state-sponsored stem cell research in New Jersey and increased cigarette taxes in Oregon to fund health care for uninsured children.

New Jersey voters had not killed a statewide ballot measure since 1988.  The rejection was a defeat for Democratic Gov. Jon S. Corzine, who campaigned heavily for the plan to borrow $450 million over 10 years to finance stem cell research.

“The public understands the state has serious financial issues that must be addressed first,” Corzine spokeswoman Lili Stainton said.

No state has more serious financial issues than California right now.  And voters are listing the economy as a greater concern than Iraq at this point in time.  Ballot-box budgeting ends up producing results that are popular but not necessarily effective.  Painful solutions regarding revenue and spending are the only way to dig us out of the mess the so-called leaders in Sacramento have created, and voters aren’t entirely likely to be informed and sanguine enough to pull the trigger on that.

This is why I continue to maintain that universal health care ideas on the state level are doomed almost by definition, and particularly in a state with the looming budget troubles like we have here. 

The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house-in this case the insurers, the providers, and other agents of the status quo-always wins. The new raft of reforms may prove different, but they probably won’t. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail-because fail they almost certainly will […]

One of the great things about state governments is that they have more freedom than the federal government does to test new policy ideas. But it pays to look honestly at what the results of those tests actually say. And in this case, the results are pretty clear: states are no good at delivering universal health care.

No one can doubt the role Massachusetts and California have played in reinvigorating the debate over national health care. And if the reforms currently percolating at the state level help provide momentum for a national health care system in the next few years, all the effort will have been worth it. If they don’t, however, they may ultimately prove detrimental. If high-profile efforts like those in Massachusetts and California can’t be properly implemented, or are launched and then collapse, they’ll become powerful weapons in the hands of protectors of the status quo.

There is a world in which bad policy ideas can actually be worse than now policy at all.  We have to tread very lightly and ensure that doesn’t happen in California.