While some of our California media have been distracted from health care issues in the last two days because of the big story–burning celebrity oceanfront mansions in Malibu!–the national news has taken note of Schwarzenegger’s plan.
What’s interesting, both in the state and national news, is how this debate is portrayed.
Media stories, which thrive on conflict, simply fall into old debates, even if they are not totally applicable.
One trope is to make this an illegal immigration story, even though it is a relatively small portion of the story. Undocumented immigrants are not anywhere close to being a majority of the uninsured, yet that get a disproportionate focus of media attention.
Many of the stories I’ve seen focus on the employer fee, with the predictable business/tax spin. The thing is, the employer fee is a real small part of this proposal. Most businesses provide 7-10% of payroll for health care… that’s far more than the 4% assessment, which is only levied, it seems, only if the employer is simply providing no coverage whatsoever. With 80% of employers being exempt for being too small, it also doesn’t touch those larger employers that may have many uninsured workers–since theyo impose signficant premium costs on their workers, or force workers to wait for a year or two to get coverage. I’ve seen lots of media stories where the businesses interviewed actually wouldn’t be impacted by the Governor’s proposal. The employer fee only raises $1 billion out of the $12 billion that is cited. Again, this gets disproportionate interest from the media, given its relatively meager scale.
Finally, a common media story is that “everybody gets a little, everybody gives a little,” of the stakeholders, including insurers, employers, doctors, hospitals, and individuals. In this context, any objection–like our opposition to the individual mandate–looks self-serving on behalf of who we represent.
Unlike those other “stakeholders,” consumer and community groups have been active proponents of many health care reform proposals–to cover workers, children, or all Californians–and all required some form of an individual contribution. But all the other “stakeholders” have their contributions capped with consideration for the ability to pay, and that’s why it falls short of “shared responsibility.”
But my main problem with the frame is that consumers are another interest group. My point is that “individuals,” whether as patients, workers, or the public, aren’t just “stakeholders.” No one would say that the system should be designed to primarily benefit insurers, hospitals, doctors, or employers.. everyone says that it should primarily benefit patients. In my mind, helping health care consumers is the entire point.
And despite the (relatively small and capped) contributions of other stakeholders, the Governor’s proposal shifts the most burden and financial risk onto the individual–especially those over 250% of the federal poverty level (roughly 25K for an individual; $50K for a family of four) who get very little help. They are forced to buy private coverage as individuals, without the market power of group purchasing, without subsidy, and with little guarantee of the quality of the coverage.
There’s a Sacramento game to watch about how the different interest groups fare, but at the end of the day, the question should be how Californians fare.