Two experts, two positions, one huge issue for Californians


Welcome to our first edition of Point-Counter-Point. This new feature will look at two opposing takes on important current and popular issues. This edition we debate the California Health Care initiative (ABX1 1). Please feel free to leave your comments (link at the end of this article).


When Perfect is the Enemy of Good

When Perfect is the Enemy of Good—or Why I’m Not Campaigning Against ABX1 1

By now, you likely know that the mostly Democratic California Assembly voted to approve a health reform bill that is strongly supported by Governor Schwarzenegger, that, if enacted, would result in the largest expansion of health insurance ever adopted by a state. Briefly, the plan would result in 70% of the state’s 5 million permanently uninsured residents obtaining health insurance and would require insurance companies to provide coverage to every applicant, regardless of health condition (“guaranteed issue.â€?) Californians who already have insurance will see no change in their coverage. They will, however, be able to obtain new coverage should they change jobs, or become unemployed and suffer from a health condition that might have rendered them uninsurable in the past.

The State Senate will hold its first hearing on this bill on January 16th and is expected to vote shortly thereafter. If the bill is approved by the State Senate, approximately a million signatures must be obtained in order to place the financing mechanism articulated by the bill before the voters in November.

Supporters include every Democratic lawmaker in the Assembly, Consumers’ Union, Calpirg, SEIU, AFSCME, the governor, the California Hospital Association, United Farmworkers, Kaiser Permanente, Blue Shield, and Safeway Corporation. Opponents include every Republican in the Assembly, the California Nurses’ Association, Blue Cross, State Senator Sheila Kuehl (Author of “SB 840), and the National Federation of Independent Business.

State Senator Kuehl and the California Nurses’ Association (“CNAâ€?) are opposed to ABX 11 and are instead supporting a single payor system. While this writer also supports SB 840, I also strongly believe that until we have a governor who has signaled that he or she will sign a single payor bill, we must cast about for the next best alternative to provide more California families access to care as soon as possible. Our health care infrastructure isn’t ailing—it is almost irretrievably broken. While ABX 11 is not perfect, it does provide affordable health care coverage that provides rewards for high quality preventive care, to 70% of the permanently uninsured. And since we know that health outcomes are integrally linked to access to coverage and care, that means that millions of Californians are suffering now and would likely be helped by this bill. Moreover, this bill already has the support of over 64% of all Californians, and over 70% of all California Democrats support this measure. This is relevant because all of us will be called upon to vote for additional taxes (increased cigarette and hospital taxes) to fund this measure in November. SB 840 does not have the requisite support in the Legislature to survive the governor’s veto again.

Governor Howard Dean often repeated Voltaire when challenged in the 1990s before he ran for President, when he created a program in Vermont to cover all children entitled, “Dr. Dinosaur.â€? His program was one of the most ambitious in the country at the time and forced pharmaceutical companies to agree to bulk purchasing, driving down health care costs in his state. He did not, however, have the requisite support in his Legislature to cover all Vermont residents. There were some in Vermont who believed that the governor capitulated and that his program should be shelved until all Vermont residents could obtain access to care. Dr. Dean disagreed and argued, citing Voltaire, that ‘the perfect is the enemy of the good,’ and that he would rather cover all Vermont children, than find himself 10 years later with no new Vermont residents obtaining care because of the inability come to any consensus.

You may not know that the Canadian health care system, often cited as an example of a single payor system that enjoys a high satisfaction rating amongst its users, also started incrementally. It began as an experiment in Saskatchewan in the 1960’s. Only when Canadians from other provinces became convinced that such a system could work, did they fight for single payor care in their provinces. Now, even conservative lawmakers in Canada know better than to threaten universal care. What if this system hadn’t begun—incrementally—in Canada?

Perhaps ABX 11—a means to provide coverage, with an emphasis on preventive care and chronic disease management—to 70% of Californians currently without access—is a means to educate those who would block efforts to make health care available to everyone. If we defeat the imperfect to wait for the perfect…it is possible that not one more Californian without access to care will be treated while we wait…and wait…and wait for a consensus that will likely not occur.

by Terry Leach

Terry Leach is a health policy consultant for a California employer (and her views do not necessarily reflect those of her employer’s). She is a health care attorney and registered nurse. From 2002-2005, she served as State Senator Tom Torlakson’s health care consultant. Since then, she provided health policy strategy to the John Garamendi Lt. Governor’s race, and provided political and policy consulting to the major non-profit supporting embryonic stem cell research. She is a graduate of Boalt Hall School of Law (U.C. Berkeley) and lives in Orinda with her family.


What We Need Is REAL Health Care Reform!

For the last year, the health care reform discussion in California has focused on proposals by Governor Schwarzenegger and Speaker Nunez that claim to provide universal, affordable coverage.

A very complex compromise bill, ABx1 1, recently passed the Assembly, although major final amendments occurred so late that careful examination of the implications was impossible. This “reformâ€? attempts to correct some of the more outrageous problems caused by financing health care through private insurance, but it does not deal with the fact that the financing system itself is the problem. Thus, it is doomed to be ineffective and unsustainable. It can not truly achieve the goal of universal, affordable care.

What would real reform look like? It is already in the legislature – SB 840 – sponsored by Senator Sheila Kuehl. SB 840 has received far too little attention during the last year, but it has passed the Senate and the Assembly Health Committee, and will be taken up again when the legislature reconvenes.

SB 840, a single payer system, is the only that reform that will ensure comprehensive care to all Californians regardless of their age, health, or employment status. By contrast, as long as we operate under the fragmented, profit driven private insurance system some of us will be well cared for, and others will be denied necessary, timely care based on their ability to pay. The key word here is “comprehensiveâ€?, not undefined “minimumâ€? coverage.

When everyone has the same level of care, we will no longer hear about tragedies resulting from inability to pay. Nor will we hear about hardworking people brought to financial ruin in trying to secure needed care for themselves or a family member.

While everyone must share in the costs of coverage for all, we must spread the burden according to ability to pay. Replacing unpredictably escalating premiums and out of pocket costs with known tax rates on individuals and employers will ensure that all contribute, but that none must chose between inadequate coverage and unbearable costs.

Most important, SB 840 is the only reform that will allow us to establish a system that controls the overall costs in the system – the key to sustainable reform. Until we develop a meaningful system of quality improvements, and also eliminate the excessive waste of fragmented private insurance, we cannot hope to create a rational system that controls costs effectively.

The numbers of individuals and organizations that support the grassroots campaign for passage of SB 840 is continually growing. Achieving real reform will take effort on the part of all of us, however. Our legislators and the Governor must know that their constituents want reform to be done right! Learn more and get involved by going to !

By Pat Snyder

Pat Snyder, PhD is a retired RN with a background in nursing administration. She serves as Chair of Health Care For All – Contra Costa, as Legislative Consultant for the League of Women Voters of California, and as Health Committee Chair for the league of Women Voters of Diablo valley.

Leave a Reply