March 17, 2007
The Schwartzenegger Plan
Gov. Schwartzenegger spoke yesterday to a conference of health care journalists that I'm attending here in California. I was struck by his confidence that a universal health insurance plan will pass the California legislature this year. If he's right, that as much as anything will set the tone for the 2008 presidential debates, since if Sacramento passes a version of the Schwartzenegger plan, the nation will have two major states (Massachusetts is the other) that passed plans that have mandates requiring individuals to buy insurance at their core.
What are the hallmarks of the Schwartzenegger plan? It contains a statewide pool for the working poor and near-poor without insurance funded by an employer pay-or-play payroll tax of 4 percent. For everyone else who doesn't have insurance, it contains an individual mandate to buy catastrophic plans. Responding to questions expressing fears that this would reduce access to routine and preventive care, his experts replied that they're working on providing additional benefits from the pool for everyone with catastrophic plans.
As far as I can tell, there was very little in the California plan to reduce costs for the entire system; restructure the delivery of care to reduce error, improve outcomes and improve satisfaction; or do much beyond lip service to encourage wellness and prevention. In other words, Schwartzenegger's plan is designed to achieve a political consensus on getting everyone into the system by raising taxes marginally on lousy employers (4 percent of payroll for low-wage workers is far less than the cost of a good insurance policy) and impose mandates for lousy plans.
It fails to take on any of the providers who profit from the current system. Indeed, he gives them additional profits so they won't complain.
In 1993, Bob Dole, then the minority leader in the Senate and a key player in the emerging health care debate, told President Clinton that he could have an employer mandate to get everyone in the system. Clinton turned him down and instead opted for a Rube Goldberg contraption to control costs that drew the ire of every special interest in the system. Now, we're seeing proposals for Rube Goldberg machines on the financial side to get everyone in the system, with virtually nothing to hold down costs or improve quality of care.
The problem of the uninsured is a moral blot on this nation, and a major reason why there is political impetus (again) for reform. But how we do it is crucial, since getting everyone the same inefficient, mistake-prone, over-technologized, overpriced care I get only postpones the day of reckoning for the U.S. health care system.
Posted by gooznews at March 17, 2007 01:29 PMIt always puzzles me how much political conservatives love the insurance industry, despite the fact that it seems to exist primarily to create inefficiency in the system by working hard to deny care and access. Any system that attempts to maintain the status quo and preserve a private insurance based system will not achieve the efficiencies possible with a single payer plan that cuts out their 20% or more of profit and administrative overhead.
Mark
Posted by: Mark Ebell MD, MS at March 19, 2007 07:42 AMBut Mark, how can these poor insurance companies continue to function if their profits are cut by 20%? I am sure they will use the same market-driven arguments that enable the pharmaceuticals to maintain inflated prices.
Posted by: Melody at March 19, 2007 09:38 AMMr. Goozner raises many critical issues in this post-THANK YOU! I agree with your analysis; the CA Governator's plan largely represents more convoluted pandering to the insurance industry. I'm a nurse in MA and have more than a few critical things to say about the MA reform plan, many of which are stated below in my recent reply comment to Senator Richard Moore, co-Chair of our state legislature's Health Finance Committee.
I work 2 jobs, have 2 small kids, so hope you'll forgive me for not writing an entirely new post. Instead I'll share the following excerpt that I wrote recently. It seems like health reform in the U.S. needs a highly trained and coordinated Health Reform Truth Squad, because for whatever reasons the MSM is not doing a very good job at getting the facts and/or critical analyses out there for the public to consider. This has been the case for the 20 years I have been a health reform activist.
"Thank you for your reply [to me], Mr. Moore. Unfortunately, it is you who miss the point if you do not understand that health system reform cannot be successful nor effective without using an approach that treats it as a system. As a system it is comprised of 3 major components:
1. Access to care
2. Quality of care
3. Cost of care
These 3 components are interrelated and interdependent.
Not understanding this system dynamic or intentionally crafting reforms that ignore it in order to placate powerful interest groups such as the insurance industry and/or powerful hospital chains, is like trying to treat a person having a heart attack without understanding and addressing the interrelatedness and interdependence of the heart, the lungs, and the brain.
This approach is quite likely to have disappointing and harmful results, just as our current reform plan that builds on the wasteful and costly private insurance industry without enacting fair and meaningful cost controls will have disappointing and harmful results.
Health policy experts, authors of journal articles, books and major research projects on health reform and health system economics understand this and have published on it. Many health care providers understand this. Many patients and family members understand this. I understand this.
I have worked in health care for almost 30 years, the last 15 years as a Master’s-prepared nurse..."
Here's link to the full thread and others on the MA reform plan on the NPR-WBUR MA Health Reform blog "CommonHealth" http://blogs.wbur.org/commonhealth/?p=21#more-21
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For folks who really want to follow the MA reform, a recent CommonHealth post by Bill Walczak, CEO of a Dorchester MA, Community Health Center is a must-read. Here's that link http://blogs.wbur.org/commonhealth/?cat=19
Posted by: AnnEM-aka-WorkingNurse at March 19, 2007 02:17 PM