California speaking…

At the California Speaks town hall, the first question was “what brought you here today?” I walked around the circular tables to listen to a handful of the several hundred folks in Sacramento (of over 3475 throughout the state). A few had their health care experiences, and had a special interest. But the biggest refrain I heard was best summed up by one man who said, “I feel powerless,” and came because he wanted a chance to be heard.

In fact, it was remarkable, as Senator Perata mentioned, for so many to come out for a full Saturday in the summer to talk about health care policy. So in that respect, it was a success and worthwhile. (Add that to the crowds that came out to rally for universal, single-payer health care in Los Angeles, and assorted other campaign activities by Its Our Healthcare and others, and you had a lot of Californians engaging in the health care debate this weekend.)

It was also impressive logistically and technologically, to see the many staff and volunteers, the satellite hook-ups, the touchkey voting, the computer networks, and the mechanisms to translate discussions and opinions into broad themes that can be voted on.

At the same time, there was some things that could have been done better. As an advocate, I have my proposed edits to the discussion guide, about items that were inaccurate or misleading, but they got many of the big issues right.

I certainly have issues with some of the framing of the questions. I think they bought in too much to the Governor’s framework of “responsibility” to different “stakeholders,” rather than, for example, a consumer-focused frame that works to remove the barriers that people have to health care.

If nothing else, it seemed invert the focus health care reform on the potential burdens on individuals, employers, insurers, rather than the benefits, which then require instituting new rules in order for the benefit to be achieved. Normally, you ask a question like “would you support covering X more California children if it meant raising the tobacco tax by X amount?” Many of the questions asked of the audience asked if folks would support an individual mandate, an employer mandate, etc, without explicitly stating the benefit. For some questions, there wasn’t a clear sense of the impacts–both positive and negative–and how they worked together.

But despite this inverted question, people tended to say they would support new responsibilities for employers, government, insurers, and individuals–but under certain conditions. The conditions reflected the concerns and hopes and issues and desires of Californians, and are the nuances that worth thinking about in the next few weeks of this health reform discussion.

There was some wasted potential with the forum. It tried too hard to steer clear of the major ideological battles in health care reform: the one between the philosophy of shared group coverage vs. individual responsibility; the role of government vs. market forces; etc. This is the debate that President Bush brought into stark relief with his opposition to SCHIP renewal. On the flip side, the forums in Humboldt and Oakland almost revolted over the desire to discuss single-payer, and while it was discussed at the end, it should have been placed up front as matter for consideration (as we had advocated with the organizers of the event.) There’s no need to sideline SB840 from the discussion; or force a false choice between it and other proposals on the table. In fact, it is a useful standard by which to judge other proposals and how they may get closer or farther to that goal. I also think it would have been useful to also have the audience weigh in with some of the Republican proposals to “increase choice” by eliminating mandated benefits, for example. (The “removing regulation” performed the worst of the cost containment options, however.)

At the same time, the health care debate could have benefited from additional input from the 3500 assembled, around specific key issues, such as what is affordable for an individual?, and what constitutes insurance? These are key issues left to be addressed, and I think Californians would have provided useful insight into the policy discussions now underway.

Health Access California promotes quality, affordable health care for all Californians.

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