The stakes…

Bob Laszewski at the Health Care Policy and Marketplace Review, an observer of the national heath policy debate, make a couple of interesting points in his latest blog post about the upcoming ballot campaign.

He correctly notes that the California reform backed by Governor Schwarzenegger and Assembly Speaker Nunez is very similar to the plans of the leading Democratic presidential candidates–Edwards, Obama, and Clinton.

He places huge import of the November 2008 vote on this ballot measure, not just on the fate of California’s reform, but of the reform conversation at the national level, regardless of who wins the presidency.

I agree that if California is able to pass reform, just as a new president is being elected, that would be a huge boon to the national effort. It would give the new President a mandate for health reform.

What if the ballot measure loses? Laszewski thinks it would stifle the debate. Losing would not be good, but I am not so sure it would stop the national effort. In 1992, California had a health reform proposal, Prop 166, that only got 32% of the vote, but that didn’t stop President Clinton from his major attempt at health reform.

In fact, the experience of Health Access California is that key consumer advocacy issues that were initially unsuccessful at the ballot became some of our biggest legislative victories in the past decade.
* Consumer groups placed HMO consumer protections–Props 214 and 216–on the 1996 ballot, which got no more than 42% of the vote, but which led to the enactment of the HMO Patients’ Bill of Rights by 2000.
* In 2005, the prescription drug companies spent $80 million to defeat Prop 79 to have the state negotiate drug prices for uninsured and underinsured Californians, but a different version of that bill was signed into law in 2006.

Two health coverage issues were on the ballot in recent years–a minimum employer contribution to health care, and a tobacco tax to fund hospital care and children’s coverage. Both lost, but very narrowly (49%, 48% respectively). The election result did not stop the momentum behind those ideas; in fact, both concepts are in the new package now backed by the Governor and Speaker.

From the right, we also have conservative groups returning to the ballot in 2008 after losing previously, on property rights and eminent domain for a second time, and on parental notification for abortions, for a third time in a row.

Don’t get me wrong: it’s much better to win. Much. But in California, losing on the ballot is only losing when you give up. And if you don’t try, you’ve given up and you’ve lost to begin with.

Final thought: The much bigger deal to the prospects of health reform at the national level is who is elected President. And it would be interesting to have the most prominent Republican Governor in the nation stumping for a health reform package that is similar in its outline to that of the Democratic presidential candidate.

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