“The gold standard”

Wednesday, February 28, 2007

* Crowd of SB840 supporters fill up hearing rooms; spill into Capitol hallways
* Sen. Sheila Kuehl fields questions from reporters, committee members

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After five years, Sen. Sheila Kuehl’s efforts to pass a single-payer health system continues to see support grow. The senator unveiled SB840 — again – on Tuesday, with more than a dozen lawmakers as co-authors, many standing by her side. The list of supporters include Speaker Fabian Nunez and Senate President Pro Tem Don Perata, even though they each have their own health reform measures on the table this year.

Longtime supporters of the effort, such as the California Federation of Teachers, California Nurses Association, California School Employees Association, Health Access California, Health Care for All, League of Women Voters, Service Employees International Union, and many others also stood with the senator, as she fielded questions from reporters. Many groups, including American Medical Student Association, California Alliance for Retired Americans, CNA, CSEA, Gray Panthers, Health Care for All, SEIU, Older Women’s League and others brought dozens of people.


Sen. Kuehl’s bill would create a single, universal, health insurance pool. Every California resident would receive a card and be allowed to see a doctor.Private medical groups and hospitals would continue to exist, but be reimbursed from the universal system, rather than dozens of private insurance companies and public funds, all with their own rules and paperwork. This change would provide savings from thus reducing the money that goes to duplication, administration, and profit.

The system would be financed through a tax system that replaces all the dollars currently paid into the health care system today, including premiums (from employers and employees), copays, and deductibles, and the money now spent on government programs such as Medicare and Medi-Cal.

For health advocates, single-payer in California is “the gold standard for affordable health reform” to evaluate other proposals, as Senator Kuehl put it, allowing the state to eliminate $20 billion administrative and profits of private insurers, save money by buying in bulk, using health technology to eliminate expensive errors and provide everyone in California with the health care they need with they need it.

But Kuehl was frank with the press. She recognized that the Governor may not sign this bill if it passes. But for every year that this bill continues to be introduced, it helps bring the conversation about health reform further along, she said. “I welcome the debate because I think we win this debate. We win it because the facts are on our side… We win it because, unfortunately, the decomposing health system is on our side,’’ Kuehl said.


SB840 and Kuehl supporters, including health advocates – but also, school secretaries, nurses, uninsured residents, teachers, shop stewards, doctors, medical students, retirees and many others — arrived early for the 1:30 p.m. hearing, lining up outside the hearing room more than three hours in advance and crowding out many regular Capitol lobbyists.

Those who didn’t fit in the hearing room, watched on the flat-panel TVs in the hallway as Kuehl gave succinct testimony and showed a documentary about why California needed a single-payer system.


Assemblymembers – many of whom have voted for the bill and stood with Kuehl — questions were wide ranging and tested Kuehl on the exact mechanics of a single-payer plan.New

Assemblywoman Fiona Ma asked whether she’d still have a choice of providers, as she does now with her private insurer. Yes, said Kuehl. All doctors would have the option of contracting with the state system. However, should a particular doctor choose not to, then their patients would have to pay in cash, just as is done now.

Assemblywoman Patty Berg feared there might be an exodus of medical providers in the state should such a system be enacted. Kuehl asked, where would they go?

“Physicians are not in a cushy place these days,’’ said Kuehl, pointing out that physicians are having a difficult time getting paid – not only by public programs such as Medi-Cal and Medicare – but private insurers. The problem is so bad that a cottage industry of attorneys has sprouted to help physicians recover money. The Wall Street Journal and New York Times’ Paul Krugman wrote about it this month. A single-payer system may be an improvement.

Assemblyman Alan Nakanishi, an ophthamologist and the only Republican to speak up on Tuesday, asked how the system would hold down costs, and adequately compensate physicians. Kuehl said Medicare and Medi-Cal both take care of the sickest and most expensive populations in the country – the elderly and the poor and disabled. And Medicare rates, it has been reported, pays for the cost of treatment. Aside from that, the system would hold down costs because it would eliminate administration and profits (also allowing higher reimbursements), take advantage of economies of scale and new technologies and the ability to plan, rather than having each medical group and hospital have to scrimp and save to buy its own systems.

Kuehl noted that in Russia, after the collapse of their health system for seniors, the average life expectancy for a man declined from 79 years two decades ago to 59 years now. “I don’t know if anyone can imagine this country without Medicare now. The seniors would be in the emergency rooms,’’ she said.

Nakanishi continued to counter that Medicare was inadequate. Kuehl replied: “If you way Medicare is inadequate, let’s make it adequate. Not say SB840 won’t work.’’

Assemblywoman Loni Hancock asked how Kaiser Permanente would shake out. Kuehl, who said she had been a Kaiser member since the 1960s, said the self-contained medical company would remain intact but its role would change. It would no longer be an insurer, but its cadre of physicians, hospitals and medical services would contract with the state as a large medical group. She said she believed such legislation would be a “boon for Kaiser’’ and said she relied on Kaiser’s model and innovation in health delivery systems to serve as the basis for many parts of her legislation.

Health Committee Chairman Mervyn Dymally asked how the unemployed would be covered. Kuehl said they would also be covered, but also pointed out that in California, most people aren’t chronically unemployed. In fact, 80% of those who are uninsured are in jobs where they are not offered, or qualify for health insurance.

Dymally also asked whether non-traditional services, such as acupuncture and chiropractic would be covered. Kuehl said they would.


In addition to the mechanics, Assemblywoman Patty Berg asked what core principles should be in a health reform package – as an interim step — should SB840 not pass.Kuehl listed three notions: Shared responsibility, market reforms, and expanded risk pools.All the current proposals rely on the idea of “shared responsibility,’’ Kuehl said. But it means “different things to different people.”

As for market reforms, Kuehl cautioned that market reforms did not mean stripping away benefits to make packages “cheaper,’’ what she called “race to the bottom.’’ To her, it meant not only banning the practice of denying applicants based on health conditions, but also ensuring insurers did not have incentives to delay patient care.

And lastly, Kuehl cautioned against the trend to segregate the market, putting less healthy people into one pool, and healthier people into another.


Because of the large number of supporters, Dymally limited testimony, but organizations who showed up to support SB840 included:California Nurses Association, Health Care for All, California Federation of Teachers, California School Employees Association, Service Employees International Union, Californians for Racial Equality, Health Access California, California Physicians Alliance, California Universal Health Care Organizing Project, Unitarian Universalists, Neighbor to Neighbor, Older Women’s League, League of Women Voters, Friends Committee on Legislation, California Alliance for Retired Americans along with many single members and interested people – from organic farmers, school bus drivers, school faculty and hundreds more.

The committee meeting was only an informational hearing, the second part of a hearing from last wek that considered other health reform proposals. The bill is expected to go through the legislative process once again, starting with the Senate Health Committee, chaired by Senator Kuehl herself.

Health Access will continue to follow SB840 throughout the year. Please tune into our website and blog (at www.health-access.org/blogger.html) for more updates in the future.

For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access California, hquach@health-access.org.

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