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Gasping for Air 

Legislative strategies for rescuing health care in California

Thursday, Apr 24 2003
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Photo by Debra DiPaolo

In most parts of the developed world, health care is considered a basic human right. Not so in the United States, where all attempts at universal coverage have failed spectacularly. A California ballot initiative 10 years ago mustered just a quarter of the vote after insurance companies poured millions of dollars into the opposition campaign. Since then insurance premiums have skyrocketed (30 percent from 2001 to 2002 alone) and a record number of Californians — at least 1 in 5 — lack any coverage at all.

Los Angeles County, home of the largest number of uninsured residents in the nation, has been hit particularly hard — ambulances are routinely turned away from overcrowded emergency rooms, and waits for doctor visits and simple procedures can drag on for months.

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The situation is so dire that despite the state’s $35 billion budget gap, dozens of state legislators are backing five separate health-care-reform bills. The most comprehensive plan — and the only one that would cover all 37 million Californians — comes from Sheila Kuehl, the intrepid state senator from Santa Monica. SB 921, Kuehl contends, would save billions of dollars in administrative costs.

The bill, co-sponsored by Gil Cedillo (D-Los Angeles), Dean Florez (D-Shafter) and Majority Leader Don Perata (D-East Bay), is slated for a hearing before the Insurance Committee on April 30.

Kuehl spoke this week with the L.A. Weekly’s SARA CATANIA about the bill.

L.A. WEEKLY: California is in the midst of the worst fiscal crisis in state history. Is this any time to be undertaking a massive overhaul of health care in the state?

SHEILA KUEHL: It’s the perfect time to undertake a massive overhaul of health care because the single-payer system is the only one that actually saves the system money. It costs no new money to the state. It would fold what the state is now paying for health care into a much larger system. That would include every person in California. So, in addition to each person’s own payments through either an employee tax or a payroll tax, it would take the place of all payments now made for premiums, co-pays, deductibles, the medical part of worker’s comp and everything else that people pay for health care, including the tax money that we waste in emergency rooms.

A significant percentage of businesses in California do not provide any health insurance now. For them, the argument is that this is not affordable, that it will drive them to ruin.

There are a couple of interesting answers to that. We’ve got a number of small-business men and women who have been testifying for the bill, and we’ve received a number of letters of support for two reasons. One is the small businesses that do provide health care — even just a modicum of health care for their employees because they want to do the right thing and they want to compete — are just drowning because there is no predictability for them, no rationalization of what they pay. It just goes up and up and up.

The employers who don’t pay it now, I think, are probably going to find that one way or another the burden of the health-care system is going to fall on them. Because the most popular plans that are being proposed at the moment are ones that level the playing field by requiring all employers to pay something.

The other plans, by and large, only apply to people who are employed —

While they’re employed. What I mean is, this week you’re working, let’s suppose next week you’re not. You don’t have coverage. So it really makes your health-care coverage a crapshoot for you, depending on whether you’re employed or not.

One concern about your plan is that it would lead to rationed care. People — because they would have unfettered access to doctors — would rush to get treatment at the slightest provocation. The demand would increase, and the supply would not be sufficient to meet this increased demand.

I think it’s just the opposite. I think what we’ve got now is rationed care. Your coverage could shrink every time your employer chooses a plan for you. You could lose your own personal doctor because your employer decides to join another plan and your doctor doesn’t happen to be in it. Ask anybody who’s covered now. You say, I’d like my hysterectomy now, and they say, “Oh no, no. You were covered last year for a hysterectomy, but this year there’s a $5,000 deductible.” What we have now is rationed care.

Is universal health care ultimately a state issue or a federal issue? Even if your plan went forward and got adopted, California is just one state. You still have to deal with the tangle of federal health-care funding.

But if you think of it from the point of view that California is one-sixth of the country — that one out of every six Americans lives in California — it’s totally appropriate that if we are going to test the system, we would test it here and not in Rhode Island, where it wouldn’t show the adaptability that it might for the country. I think this would be a significant “pilot program,” if you would, for the nation.

Frankly our federal government is showing no will to help anybody do anything these days. Quite the opposite. And I think that it’s also important that some states have the will to show by example a serious critique of privatization ideology, which has taken over our federal government. Managed care is a failure. We need to take it back.

What’s your sense right now in terms of political will?

Well, I have a number of co-authors, and people don’t really focus until you have a hearing. My philosophy, even from my very first year, has always been: “One impossible committee at a time.” I mean that. I think I’ll stitch a sampler.

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