Focusing the Health Care Debate on California
In my recent post, I referenced how California consumers can get involved in the national health reform debate. But even with so much happening in Washington, D.C., Californians should also pay attention to what’s going on in Sacramento.
My colleagues Ellen Wu and Lark Galloway Gilliam appropriately spotlighted the state’s fiscal crisis and the potential impact of the budget cuts proposed by Governor Arnold Schwarzenegger. The health care cuts could deny coverage to nearly two million Californians [PDF] and have severe impacts on a range of health programs, services and providers on which we all rely. Health Access has a one-page flyer that summarizes all the health cut proposals [PDF] by the Governor.
California has better budget choices, including raising the taxes and revenues needed to prevent these and other devastating cuts. We need to avoid not just the tragic human impact of the cuts, but the consequences to our health system and our economy. For example, we lose two federal dollars for every dollar we cut to Healthy Families, the State Child Health Insurance Program (SCHIP) that insures low-income kids which is proposed to be eliminated. So for every dollar the state cuts, that’s a three dollar cut to our health system and our economy, and a greater multiplier effect beyond that.
The loss will be even greater with the passage of national health reform. In the proposals in Congress, Medicaid and SCHIP is the foundation for additional coverage expansions—and these cuts would attack that foundation in California. We would further undermine our state’s ability to bring in federal dollars and take advantage of the benefits of reform if we undo our health system’s infrastructure at this crucial time.
But Californians should not just prevent steps backward; we should take some steps forward at the state level. State-level bills on comprehensive health reform have stalled for the year, as legislators focus on the budget crisis. But there’s still progress on specific health reform on a policy level.
One bill, AB786 (Jones), sponsored by Health Access California, would set some basic standards in the individual insurance market, and help weed out “junk” insurance that gives coverage a bad name. Lark Galloway Gilliam spotlighted this issue when asking: what’s the value of coverage, anyway? We’ve talked to many patients who find out that their insurance doesn’t cover very much—often not until it’s too late. That’s why there needs to be better information and labeling of insurance products, so consumers can comparison shop and know what they are getting.
Along with the provisions of the bill which I detail at The New Republic’s The Treatment — a useful blog for those following the national health reform debate — there’s research that indicates it is impossible for consumers to figure out exactly what their policy does and does not cover. And even then, consumers aren’t actuaries, and thus have limited ability to figure out what risks they need to insure against.
The bill, authored by Assemblyman Dave Jones, chair of the Assembly Health Committee, takes a needed step toward helping consumers comparison shop in the near term. But the provisions have been part of comprehensive health reform in California, and are being considered in the federal health reform conversation. Even in a bad budget situation, California can make progress in health reform.
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I sit on the board with Utah association of Health underwriters and http://www.BenefitsManager.net as well as http://www.HealthInsuranceSource.net for health insurance reform. Several interesting changes took place with H.B. 188 passage earlier this year that seems all too familiar on the federal level. The spirit of the bill allows private market place remedies. It essentially guarantees insurance providers a “no loss” or “no gain” over competing carriers in the insurance exchange portal which is http://www.UtahInsuranceExchange.info. On the surface it seems not to be attractive to participating carriers (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees. That can be accomplished now. The other half of the equation is providers and their billing practices that need to be reformed. That is on the agenda. Keep an eye on Utah because the national health care debate seems much the same ground we have already covered.
In http://www.UtahInsuranceExchange.info which is the beginning of a state sponsored program addresses issues on a local state level that the federal level might look at. Coming from an underwriting background I know where the dime falls. I am of the opinion that large waste occurs from providers billing for procedures that developed “no outcome”. Insurance carriers are not the only bad guys on the block. In most of our purchasing decisions….don’t we pay ONLY when we know that we will get a desired outcome? Why is it if you ask the doctor how much a particular test or procedure is he doesn’t know? Shouldn’t providers be held to a transparent cost standard?
You must be in the health care business from some interaction point to make statements of fact in the face of historical changes. When you are in the system from any touch point (insurance, provider, hospital, Medicare or patient) you get the “real issues” because of real time experience.
I often quote the Switzerland health care system as an example of tough questions that we will have to face at some point down the time line. Did you know that premature babies are not resuscitate upon birth if they cannot draw breath? Did you also know that is the same with “senior care” experiencing system failure or failures? They don’t extend life of a senior with multiple failures like intubation as example. Anyone in the business of paying claims knows that the single most expensive bills in what we call “shock loss” is within NICU for newborns and seniors in acute / intensive care / hospital.
The Swiss apparently made decisions made based upon cost vs. quality outcome. Are we as a nation prepared to make that type of decision or to define when to incubate, resuscitate a newborn or a senior? To define the conditions and rules of practice? With a litigious society I think not. This is why we need tort reform. Without tort reform medical provider costs will never drop. Liability costs with medical providers are nearly half of operating expenses. With health insurance carriers it translates to about 10% of every premium dollar collected.
I don’t think we are hearing about tort reform because most of the house and senate on the federal level are lawyers and have practicing law firm interests / ownership. In the healthcare system there is no total innocence. Insurance executives with bonuses, doctors overbilling, hospitals overbilling because the street gang thug got dropped at their door with no insurance. The lawyers are there to stir the pot and promise lavish fortune at the end of the PERCEIVED misery chain. Am I saying we don’t need them? No, but I am saying there is clear and documented abuse of the legal system that awards outlandish claims in the millions for a $20,000 mistake. Ambulance chasers being the most abusive. What about those that educate their clients on defraud and then use the legal system to pirate insurers?