So tomorrow, this year’s budget battles win begin in earnest. And they will be ugly.
But before the budget battles begin, I would like to respond to those who question why we support a single-payer health care system and public program expansions, at the very same time we are actively engaged in fight over the bad decisions and priorities that elected officials sometimes make with regard to public health programs.
The question is comical, since it pre-supposes that we are naive, thinking somehow that everything that government does is right. That’s far from the truth.
The answer is in the process we are about to go through. By all accounts, Governor Schwarzenegger will propose ugly cuts tomorrow. And he will propose those cuts rather than put forward a balanced approach that includes fighting for additional taxes and revenues to prevent the worst of those cuts.
But then these cuts will be evaluated in a public process, analyzed, considered by a legislature, and negotiated throughout. Various constituency groups will make their points about the impact of the cuts. And however, tough and ugly the budget process will be, there will be a resolution.
We may or may not like the final result. (In previous budget efforts, we’ve won some and lost some.) But at least there was public discussion and oversight.
In health care, what’s the alternative? For those not on public programs, consumers have their premiums increased, their benefits cut, deductibles raised, their choices restricted and they often have no say. Those decisions are made by employers and insurers, in private boardrooms and executive suites. Not in public, not by elected leaders who are accountable for their decisions.
Many who support single-payer believe that if everybody is in the same health system, the public pressure will be there for a system to balance keeping cost-sharing low but quality high. In countries with universal health care systems, this is a active issues: In Canada, Britain, or elsewhere, elected officials compete on how they will improve their health systems.
Reforms like AB x1 1 place more public oversight over health insurers and the health sector, so that some issues, such as what a minimum benefit should include, are debated and decided in public, rather than in private. That’s much better than the status quo.
So even when Health Access and other groups are fighting budget cuts, don’t be mistaken: we support a system that allows us to have the fight in the first place.
And that’s why we’ll also fight some of the so-called budget reforms, to allow unilateral or automatic cuts, that seek to remove that public process. That’s a consistent principle through all our work.