This article written by: Former Assemblymember Hannah Beth Jackson of Speak Out California

A weekly update on the goings-on in Sacramento

For the week ending November 3, 2007

Key bills and issues we’ve been following during the

Past week and beyond

This is usually a pretty quiet time in Sacramento. While this situation remains pretty much the case,  the slowly dying Special Session still remains. With the big battle over water ending in a stalemate, the debate over  health care reform showed a glimmer of activity this week as the Assembly Health Committee held a full-blown hearing on the Governor’s health care proposal. There wasn’t any progress to speak of, although the Speaker, Fabian Nunez pledged to keep working to reach a compromise. Unfortunately, few in Sacramento believe either side will make necessary concessions to make that happen.

When times are slow, polls become more interesting-at least to those political wonks who are otherwise suffering withdrawal from relative inactivity. This week was no different as the well-respected Public Policy Institute of California came out this week with the latest on several fronts. Among these are whether the people feel California is moving in the right direction or not (which is just another way of asking whether people are optimistic and hopeful about their future) and how the Governor would fare should he decide to take on Senator Barbara Boxer in 2010 for the U.S. Senate. As you can see, a lot of inside baseball here, especially since even the baseball season is finally over.

The ballot measures for 2008 are again coming to life, especially since right-wing Congressman Darrell Issa, who brought us the Davis Recall in 2003, has announced he will bankroll the return of the Electoral College measure. For those who thought this blatant right-wing power grab was dead, this measure will split California’s electoral votes from a winner-takes-all to a split of electoral votes by Congressional District. Translated, this would likely give the Republican candidate 20 electoral votes—or the size of Ohio or Florida. Since the Republicans haven’t won California in years, this is as good as giving them a 40 vote turnaround in the Electoral College, enough so the conventional wisdom holds, to steal the election for the Republicans. And since it is felt that Rudy Guliani is the one most likely to benefit from this ploy, and there are many dirty footprints leading to his door on this measure, the Dems are howling. All this makes for good copy, of course, and keeps the political junkies busy during an otherwise slow period before the election cycle kicks in. Of course, this year, the election cycle seems to have started months ago and seems to be in overdrive already.

With so much bad press recently for Speaker Fabian Nunez’s spending habits, the Term-Limits/Extension measure Prop. 93 appears to be sliding out of favor dramatically with California’s likely voters. Added to the woes of current members hoping to extend their terms in office is the announcement by billionaire State Insurance Commissioner, Steve Poizner, that he will help bankroll the opposition to the measure. Even though the supporters of the measure have a substantial war chest, this measure looks like it may go down with a big thud.

And now for the week’s goings-on:

Health Care in the  Governor’s Special Session

The Governor finally got his opportunity to publicly roll-out his insurance-based health care plan. With his normal theatrical flair, the measure had a full hearing before the assembly Health Committee this week. Ever gracious Health Secretary Kim Belshe, presented the Governor’s now more specifically formulated proposal to a skeptical committee. Because the measure assumes that the insurance industry remains in the play—and in fact, insists upon it, there was no discussion of one of the fundamental questions in the entire debate: what benefit (if any) does the insurance industry bring to the delivery of health care to Californians? The Governor’s proposal simply presumes a benefit, although it is seriously challenged.

In fact, the basic premise of real universal health care is that there is one entity that is responsible for paying out to the healthcare providers (like the very successful and cost-effective  U.S.  Medicare/Medical system). No insurance companies, no profits, just one agency that oversees payments. That allows everyone to choose their own docs and healthcare providers who will be able to practice without insurance company interference, get paid a fair fee and discard all the bureaucratic tape of having to deal with the thousands of different plans in California alone.

But, unfortunately, the Governor’s proposal would require that all Californians buy health insurance and on that basis all Californians would be covered. Even assuming for the moment that this is a good approach, the Governor’s proposal makes the purchase of insurance mandatory, but doesn’t say what that cost would entitled us to receive and doesn’t cap the cost that the insurance industry can charge for the various services, medications, etc. that we would be getting for our premium payments.

Without any controls, the measure was predictably poorly received. In addition, there is no agreement on how to fund the program. The Republicans won’t support any system to pay for the coverage and the Dems don’t like the mandatory requirement aspects of the proposal. The Governor wants to cap employer contributions at 4%, but this is even less than what companies who are already contributing for health premiums are paying now.

During the hearing, it was exposed that the Governor’s proposal is not clear as to who is covered under the mandatory provisions requirement. Nor is there a mechanism to contain costs of premiums that the insurance industry can charge.

Another cause for concern is that minimum insurance would mean minimum coverage, so that those unable to afford much would likely end up paying for something that doesn’t provide them with the care they would need anyway- meaning they would be paying for nothing…not a very good system.

About the only point of agreement in all this is that insurance companies would not be able to reject providing insurance (such as it would be) for pre-existing conditions. Although this might seem to be a good place to start negotiations, neither side appears to be willing to concede on any of the above mentioned points. This is often referred to as a stalemate.

Hopefully, at some point, we’ll be able to get back to a meaningful discussion of whether healthcare should be available to everyone and if so, how we can construct a profit-based, yet more cost effective and equitable system to delivering meaningful healthcare to all?

For an excellent piece on the problems with the Governor’s proposal, check out Consumer Federation of California’s Richard Holober’s piece here.

Polls: a snapshot of what the people are thinking today

When times are slow, polls take on a particular interest. This week’s offerings from the highly regarded Public Policy Institute of California (PPIC) are no exception. One of the most consistent areas the PPIC investigates is how the public perceives the present and future- taking the pulse of the public’s optimism or pessimism regarding the days to come. While it tends to fluctuate significantly, trends are often discernable and serve to highlight the kinds of policies and leadership the public wants or believes it is getting.

Right track or wrong track?

The current pulse shows that Californians are evenly divided on whether they believe the state is on the “right track” with 42% believing we are and 42% believing we’re on the “wrong-track”. For those who think we’re headed in the wrong direction, 21% cite immigration and uncontrolled borders as the reason we’re going the wrong way. This represents a 6% increase from the 15% who felt immigration was the number one problem in California in 2005. Thirteen percent of those who think we’re headed down the wrong path cited education and school cuts as the second most serious problem in the state.

Those who believe the picture is rosy and headed down the right path attributed their optimism to the Governor (21%) while 19% attributed it to the state’s economy. For a further discussion of this data, check out the Sac Bee article here.

The importance of college and higher education

And while on the subject of higher education, a strong majority of Californians believe that one of the keys to success is obtaining a college education. Sadly, 56% of Californians believe is harder to get that education today than it was a decade ago. The PPIC poll shows that an impressive 76% see our state’s higher education system as a key- to our quality of life and economic well-being. There is little doubt that we need to do more in California to improve access to this vitally important path to economic opportunity and well-being. For more on this subject, check out Frank Russo’s excellent piece here.

Boxer vs. Arnold for U.S. Senate in 2010:

For real political wonks, polls showed that if there were a match-up today between Senator Barbara Boxer and Governor Schwarzenegger, it would be a statistical dead heat. While this has many progressives concerned, the governor insists he has no interest in the seat and doesn’t intend to challenge the Senator who, by virtue of her seniority, now chairs the very important Senate Subcommittee on the Environment. While one would like to take the Governor at his word, he has been known to change his mind at the very last minute—as he did when he announced his decision to run for Governor on the Jay Leno show. Not only did that announcement shock his staff, but his wife as well. So, we’ll have to stay-tuned on that one.

New or re-heated  initiatives on the horizon

Just when we thought the right-wing power-grabbers were sufficiently embarrassed and humiliated to put the Electoral College scam measure on the ballot, they’ve found a new champion to come to their rescue in the form of Darrell Issa redux. This is the measure that was originally fronted by a group with the ignominious distinction of being led by a Republican operative best known for biting the backsides of women. While this measure would certainly bite the back-side of democracy by breaking up California’s electoral votes, and possibly handing the Republican presidential candidate an undeserved victory in the 2008 Presidential election (not exactly something new), it needs a quick insurgence of cash to ensure it can qualify for the November 2008 ballot. With only a few weeks left to qualify, we’ll be seeing a lot of paid signature gatherers misleading unsuspecting voters to sign their petitions. It will be ugly and is already the subject of litigation as the Dems are not going to let this piece of undemocratic mischief see the light of day, if at all possible.

Proposition 93- The term limits/expansion initiative

The measure, sponsored by the leadership of both houses of the legislature, got some bad news this week as the polling shows that support for Prop 93 plummets dramatically when the public discovers that it will give sitting members additional time in the legislature. While the current term-limits rule has wreaked havoc on our legislative system, this proposal has far too many skeptics seeing it as an obvious attempt to keep the current leadership in power longer than it should be. Given the negative couple weeks Speaker Fabian Nunez has had over his disclosed uses of campaign funds, it is little wonder that the public is souring on this measure. For more on this story, click here.

From the Speak Out California In-box

While we often receive emails from our readers (who for some reason would rather email than post on our blog!), this week was particularly heavy on concerns and outrage over Senator Dianne Feinstein’s support of Judge Mukasey’s confirmation. Several of you were indignant that the Senator would support a candidate who will not condemn water-boarding as torture. While we generally try to focus on California issues and activity within the state, we, too, are very concerned about approving someone who hasn’t the courage or perhaps the moral compass to condemn torture sanctioned by the government of the United States. We urge those who share this concern, to let Senator Feinstein’s office know of your displeasure. Certainly, at the least, we as Californians are entitled to know why she has given her critical vote to confirm under these circumstances. To contact her office, click here.

The Rest of the Story

Our blogging offerings for the week:

Keeping big business happy at our children’s expense— A look at the conduct of the federal agency tasked with protecting our health and safety as consumers and as parents, while our children are exposed to dangerous and unsafe toys.

The Power of the Words, We the People— a look at how “we”, the people, are really “we”, the government.

To read and comment on these entries just go to:  www.speakoutca.org/weblog/

Until next week,

Hannah-Beth Jackson and the Speak Out California Team

Single Payer cleared another hurdle by passing out of Assembly committee in Sacramento this week, but it seems to be on a sort of death march to Arnold’s veto pen. That is unfortunate, but that is reality. And while it probably requires no further explanation of how wrong our system really is, it’s really wrong:

Blue Cross of California refused to extend her policy after she used the plan once for a minor infection, Campbell said, and in a pinch she bought another short-term policy from Blue Shield of California. Last summer, she worked a Friday shift, got sick over the weekend, and a week later was diagnosed with two aggressive forms of cancer — rhabdomyosarcoma and adenosarcoma. On July 20, her health insurance policy runs out and no one will insure her, Campbell told the Assembly Health Committee on Tuesday while testifying in support of Senate Bill 840.
*  *  *
“I’m too young for Medicare, and I make too much money for Medi-Cal,” Campbell, 53, told the panel. “But one eligibility worker told me how I could get Medi-Cal: ‘Get pregnant, get the Medi-Cal card, abort the baby, and keep the card.’ This is my only option.” (SacBee 7/4/07)

So, we doom somebody else because saving them isn’t profitable for an insurance company.  Ugh, just go see SiCKO, I don’t need to repeat everything here. I’m not saying the insurance companies did anything wrong, it’s that they exist in the first place that is the wrong.

But where do we go from here? Well, here in San Francisco, we have Healthy San Francisco, which signed up its first 29 applicants on Monday.  Follow me over the flip…

There are some really great things about Healthy San Francisco.  Tom Ammiano worked very, very hard to craft good policy. He had to fight the Golden Gate Restaurant Association and the Mayor, but he got it done. It’s why he’ll be a bulldog in the Assembly.  It helps cover the people that can’t get Medi-CAL nor can they afford regular insurance.  But this isn’t true insurance.  The main drawback? Well, you can’t really leave the City/County of San Francisco and expect any care.  Your pseudo-insurance card only works in the City, and is worth about as much as a Jack Taschner (who?) baseball card outside of the city.

So while it is billed as universal care, it’s not really. So, what else? Well, we have the possibility of whatever reform Assembly Speaker Nunez and Senator Perata can come up with. Of course, it better be business friendly, or you know Arnold will veto it. So, do we end up with some sort of plan that still leaves Ms. Campbell out in the cold?  My crystal ball seems a bit foggy, but I’m not convinced that the reforms being touted will truly address the inequities at the heart of the InsCo health care system.

I’d love to be wrong, though.

(oops. Feel free to disagree, I know this one is contentious. – promoted by Brian Leubitz)

The health care debate seems to be very troubling for a lot of people, and that’s understandable. And, hey!, it’s a big issue.  So, for now on, I (or somebody else) will be doing a Health Care Tuesday Post.  I know, I know, it’s no Freaky Friday or Manic Monday, but Health Care Tuesdays are what I have to offer…so go with it.  I’ll try to get these up every Tuesday around noon, but well, timeliness isn’t necessarily my best quality.  But they will be up on Tuesdays!

First, I think it’s great that people are talking about health care solutions.  That is an important first step that we all have to take.  You know, admitting you have a problem is the first step to recovery.  And so with us, here in California and the nation.  We must admit that we have a problem with our health care system before we can truly fix it.  And so, props go out to the Speaker of the Assembly, the Senate Majority Leader, and yes, the Governator for at least talking about the issues.  While they may not have all the answers, they have nudged us along on the important road to those answers. So…thanks.

Flip it!

But, what does it mean that our health care system is broken. Well, let’s look at Ezra Klein’s Health of Nations series. First of all, if you haven’t read those posts, do yourself a favor, and read them. But, a quick comparison to other industrialized nations, and you’ll see the problem.  Here is just one quick metric: number of years of life lost per 100,000years.  Ezra’s source is in French, so I’m just trusting him. WHO Data and OECD Data (XLS) also went into this table.

Health Care System performance

Country	Women	Men	Overall Perf. Rank	Overall Spending Rank	Per Capita Spending (2002 US $)
France	2588	5610	1	4	$2736
Canada	2768	4698	30	10	$2931
U.K.	2947	4815	18	26	$2160
U.S.	3386	6648	37	1	$5267

So, clearly we are spending money without getting anything in return. These additional expenses can be attributed to several different causes, and attribution of fractions to these causes is beyond the scope of this post.  But the # 1 expense that we are paying that these other industrialized nations are not is clear: insurance company expenses and profits. Over thirty cents of every dollar spent on health care goes to administration and profits for these massive corporations.  You know, it’s important that Wellpoint make its numbers or the Street will punish them.

How messed up is that? It’s like boxing Mike Tyson (the 1980s Mike Tyson, not the sad crying 2001 Mike Tyson) with your shoelaces tied together. Just when we get a punch in against illness, the insurance companies want their third.  The infant mortality rate is the highest of any industrialized nation, and Wellpoint is concerned about what the Street will do if they don’t keep on rescinding coverage for those with the audacity to actually use their insurance by getting sick. 

But here’s the political problem with ArnoldCare, FabianCare, or really any non-single payer program, if we expand health insurance instead of health care, we will be further lining the pockets of these corporations who already have a major lobbying presence in DC and in Sacramento.  We have now given the bunker buster bomb to the rogue nuclear state just to make sure that no real progressive change can ever happen.  Look, as the Senate Majority Leader Harry Reid (D-NV) said in response to a question I asked about ArnoldCare when originally proposed: “The problem is that the insurance industry is the enemy of most everything we do today. “ This would be granting even more power to the already destructive insurance industry.

So, let’s just posit that some FabianCare type program works. And looking over the program details, I think that there will be some improvement, at least in terms of gross numbers of uninsureds. I’m not ripping on the Speaker here, he’s trying to get what he thinks is the best available program passed given the political constraints. So, the program works and we cut down the number of uninsureds to say, 1 million people in the state. I think we can all grant that would be a really good result given the metric of # of uninsureds.  So, who are those uninsured people now? Good question, but do you think they have very good lobbyists in Sacramento? Probably not, b/c they are the last 1 million, right?  How are we going to go that last mile? The critical mile, if we have now bolstered the economic situation of the insurance companies, giving them additional resources to fight against single payer.  So, say we get a Dem. governor, are we really going to be able to get SB 840 passed when the InsCo lobbyists actually get to worrying about it? I mean, now they are just letting it go b/c they know they have Arnold to veto, do you think they would be so ambivalent given a Dem Governor? 

So, back to the titular question: when is good enough, just not good enough? Now. I appreciate the efforts of those who are working on insurance based solutions, but mustn’t we also realize that implementing these plans might be a huge boon for the exact reason for our health care crisis: the health insurance industry?  Wouldn’t this actually slow the implementation of the only plan that actually works: single payer.  Look, single payer isn’t perfect, but until resource scarcity is a thing of the past (you know on the 12th of Never), it is the only feasible solution.

I know that some people will disagree with me, and I surely appreciate that.  I suppose having overpriced health insurance is better than flying with no net.  That is a scary thing (and it’s something that I’m staring down the barrel of), but deals which only prop up the insurance industry as they continue to raid our health care system will not truly solve the problems that we are facing.

So, over the next few weeks, I’ll address several major issues in the arguments for and against single payer guaranteed healthcare.  Next week (probably): The Myth of Moral Hazard.

I stumbled upon this LA Times article about patient dumping after a conversation with a friend who happens to work with uninsured patients at a hospital. Apparently, Kaiser is really, really sorry about dumping unstable (both mentally and physically) patients.

Kaiser Permanente has agreed to a first-of-its-kind settlement aimed at ending patient dumping that requires the HMO to establish new discharge rules, provide more training for employees and allow a well-known former U.S. attorney to monitor its progress, officials announced Tuesday.

The agreement by the nation’s largest HMO could resolve criminal charges and civil lawsuits filed against it last year by the Los Angeles city attorney’s office, alleging that it dumped on skid row a homeless woman who had been a patient.

Prosecutors, who are investigating more than 50 cases of dumping in downtown L.A. over the last two years, urged other hospitals to adopt the same rules that Kaiser has accepted for its 11 hospitals in the region. … Dr. Benjamin Chu, president of Kaiser Permanente’s Southern California region, apologized Tuesday for dumping the woman and said Kaiser is committed to changing. (LA Times 5.16.07)

Awww…we’re so so sorry, now pay up!  But in the end, you can’t really blame Kaiser or Blue Cross or or any of the inscos, they can’t bear the brunt of all of these costs.  The problem isn’t that the insurance companies are doing what’s in their best interest, it is that these kinds of things are in their best interest.  Or put more simply, it’s that there are insurance companies.  We give these companies incentives to get rid of the poor, and we expect them to act differently.

We need comprehensive health care reform, not just more subsidies for insurance companies.  We need more clinics to address daily health concerns, we need more spending on mental health facilities rather than dumping the mentally ill on the street. We need to take the long view, and get the  system to actually work rather than just applying another band-aid by giving the inscos another check.

(Now cross-posted at dKos and MyDD. Also, Check out Shum’s single payer update for more on the $3.7 billion. – promoted by Brian Leubitz)

Today is going to be a busy day.  But let’s start with some health care talk in the morning.  I just got off a call with Harry Reid, where much of the talk focused, with good reason, on the mess in Iraq and the President’s posturing on Iran.  However, I’ll leave that to the national bloggers.  I highly recommend Bob Geiger for coverage of all things Senate. Oh and check out the MoveOn.org ad they are trying to get aired in DC during the Super Bowl.

I, however, wanted to address Arnold Schwarzenegger’s health care plan.  This is relevant primarily because Schwarzenegger plans on asking for $3.7 billion in new federal funds for the plan.  So, I asked the majority leader, what he thinks of California’s plan, if the Governor will get his money, and where we should go from here.

Unfortunately, I’m not a great transcriber, but he is certainly up on the issues.  However, he pointed out something that I also addressed in my post entitled “Health Insurance Sucks”, namely that the insurance industry, well, sucks:

The problem is that the insurance industry is the enemy of most everything we do today.  They have an anti-trust exemption from the Depression era that was supposed to last only a few years (the McCarran-Ferguson Act) but is still with us today.  This exemption allows the industry to do harmful things to the country. They are fixing prices, which would ordinarily be a violation of the Sherman Anti-Trust Act, but there is nothing we can do. 

More over the flip…

Well, I couldn’t agree more with the statement that the insurance industry is the enemy of good health care.  While Sen. Reid is just looking to eliminate McCarran-Ferguson, I’d like to eliminate it all together, but Reid’s strong language is a great start.  By the way, the words in bold were a direct, and accurate, quote. I was sure to get that sentence perfect because it was such a thrill to hear that from the mouth of the Senate’s Leader.

We moved on to the issues relating to Arnold’s plan:

The insurance industry is broken, there are 47 million uninsured Americans, and there all sorts of hidden costs. I’m glad that the Governor is at least taking health care on. He’s the Termainator, and that could bring attention to the issue.  But we have to see how Massachusetts works first.

There was an article by the syndicated columnist Mike Samuelson (spelling?) that said the cost of insurance in Massachusetts with their plan was twice what the state expected, or about $4600 per person. They are having problems with the costs. I think that we everybody should have the same kind of care that I have, that Congress has.

We need to first look at McCarran-Ferguson and what we can do to stop the insurance industry from hurting us.  The Gulf Coast situation is an example of that.  Even some Republicans are beginning to talk about how the insurance industry has failed us. So we could see some movement on these issues soon. 

So, I guess the big question that stands out here is whether we can afford Arnold’s plan if the Congress doesn’t plan on providing the additional federal funds. Is this plan DOA? The debate is certainly worthwhile, but don’t we need to deal with the insurance industry as well? Do we really need to give them a huge windfall that would require everybody to pay them for their overpriced  services?

California Connected, a joint production of several PBS stations in California, aired a segment about Alex, a 4th grader living in SoCal that does not have insurance.  You can view the segment here.

There a few issues that could truly be solved in the legislature. The list is short due to the influence of Prop 13 and its supermajority tax and budget requirements.  But one area which could be immediately fixed is health care.  And such a plan is currently pending in the legislature, it’s SB 840 sponsored by Sen. Kuehl.  SB 840 would change the insurance model of California to one where the state government would be the provider.

Now some would scare you by saying that we don’t want the state to choose which procedures we could get.  But let’s think about that honestly.  Who makes those decisions now? For-profit health care companies.  Who would make those decisions under SB 840? The State?  Is the state really scarier than the private insurance companies?  DOes the state have to report increasing profits every quarter?  The answer is clear: SB 840 is the right thing to do for the state’s children.

Look for SB840 to pass the Assembly but be vetoed by the “moderate” Arnold Schwarzenegger.  His insurance contributors will make sure of that.

Arnold Schwarzenegger has promoted his record of bringing enrollment in Healthy Families to record levels.  And when running for governor in the recall election, Schwarzenegger promised to provide health coverage for every child.  This much is true, more than 90% of California children now have some form of health coverage.  Now, his claims of credit are a bit more misguided:

“Frankly, I think kids’ health care in California is close to being a success story because 92 percent of all kids are now insured,” said Kim Belshé, Schwarzenegger’s secretary for Health and Human Services.

But state data compiled by the California HealthCare Foundation show programs that cover children grew much faster under Democratic Gov. Gray Davis than under Schwarzenegger. Davis was recalled, in part, because the state ran up a record budget deficit under his watch. A lot of that money went to expand the same health care programs that Schwarzenegger is now touting.

The governor’s own efforts, meanwhile, have been slowed by factors ranging from the deficit he inherited — in his first budget Schwarzenegger tried unsuccessfully to cap enrollment in Healthy Families — to resistance from his fellow Republicans in the Legislature. With their votes needed to pass a state budget, Republicans succeeded last week in forcing Schwarzenegger and Democrats to drop proposals to extend health insurance programs to all children, including illegal immigrants. The governor had earmarked $23 million to provide coverage for children in 18 counties who do not qualify for Medi-Cal or Healthy Families because their families are not poor enough or are illegal immigrants. (SacBee 7/3/06)

The governor has used the Davis boom-time legacy of spending on child health insurance to build his own record.  He has done little to actually accomplish anything that brings up the rate of enrollment, as the slowing enrollment has shown.

So, health care supporters are forced to turn to the initiative process to get something done.  The tobacco tax, Prop 86, that will appear on the November ballot will provide funds for coverage of all California children.  Now, I have some remaining questions about Prop 86, but the fact that we can’t get universal child healthcare done is a sad statement.  The GOP has chosen to make children thier pawn in this immigration game that they are playing.  It’s not right, and it’s not fair to the children of California.  All of our children deserve quality health care.