Health Reform and the Year of Magical Thinking in California

[courtesy of California Progress Report]

By State Senator Sheila Kuehl
Chair
Health Committee

The Year of Magical Thinking is the title of a memoir by Joan Didion detailing her state of denial, inexplicable behaviors and, finally, coming to grips with, the death of her husband. It’s also an apt description of the Governor’s 2007 approach to reforming our broken healthcare system, with the glaring difference that he still hasn’t come to grips with the truth. (After all, if a complicated movie plot could be resolved in less than two hours, who not fix healthcare in California in nine months?)

Beginning in January, the Governor ordered his health advisors to sketch the outlines of a plan that would magically “cover” all Californians by simply requiring them to buy health insurance. To this moment, he has refused to negotiate any of his major points with the Legislature. The language for his plan was finally drafted five months later, and shown, under wraps, to a few, select people. Not one legislator agreed with it, and no one would carry the bill as legislation.

To fill the void raised by the Governor’s magical “we must do something this year” drumbeat, the Democratic leaders began crafting their own reform plan. To date, however, the Governor and the Legislative leadership have remained oceans apart on the broad policy strokes of health care while public support for the current insurance-company controlled system has plummeted and support for the reforms contained in SB 840, the Medicare-like fix for California, has grown.

Now, with less than two weeks remaining in the first half of the two-year legislative session, there is still no “something” on the table and the Governor, like a Barnum and Bailey’s ring leader, continues to announce that he will, assuredly, pull a rabbit out of a black hat. Actually, there is no way of knowing if the result would really be a rabbit; it could just as easily be an albatross.

The Governor has further limited discussion by announcing that he would veto both of the legislative proposals that have actually been introduced as real bills. SB 840, by far the most carefully crafted, transparent and fully vetted bill, will remain in the Legislature until next year, since sending it down to him for a veto would end any consideration of single payer until 2009. The individual mandate provisions in the Governor’s pronouncement are being emphatically rejected by virtually all stakeholders representing the people who would be forced to pay uncapped premiums. The percentages to be paid by employers and individuals, hospitals and doctors, people in a “pool” and those outside, those above differing percentages of the poverty scale and those below, are so far apart in the Governor’s pronouncements and the Speaker’s bill, you could drive trucks through the gaps. The Governor’s lynchpin financial mechanism of a provider tax remains submerged under the very murky water of a 2/3 vote. What convoluted compromise might be devised in a last-minute attempt is anyone’s guess.