April 22, 2004
Can Universal Care Cure State’s Ills?
Retired cardiologist Dr. Robert Peck remembers the 40-year-old uninsured patient who was admitted to the emergency room of a local hospital with severe chest pains. The patient was stabilized, but required further treatment. Since he had no insurance, he was to be transferred to one of the county hospitals that serve the uninsured. But the patient died while awaiting transfer.
Another patient, who did have insurance, was awaiting tests after being stabilized for chest pains.
"The gatekeeper for that HMO ... not a cardiologist ... decided that this man didn't need an angiogram or even to be in a hospital," Peck recounted. "And so he sent him home."
Three months later, the patient returned to hospital with chest pains and died in the ER.
Peck's examples and a litany of statistics clearly demonstrate the failure of California's health care system: Of the nation's 43 million uninsured Americans, 6.5 million are Californians. That equates to roughly one of every five state residents. Within the last decade, 15 percent of the state's emergency rooms have closed due to skyrocketing costs. Nationally, Health insurance premiums rose almost 14 percent last year alone.
State Sen. Sheila Kuehl (D-Los Angeles) believes she has a cure for the health system's ills. Kuehl authored SB 921, a bill that would establish a single health plan for every resident in California. Under the proposed single-payer universal health care system, individuals would choose their own health care provider and everyone would be entitled to the same benefits. But instead of being paid by insurance companies or individuals, providers would be reimbursed by the state. The state fund would be financed by a tax on employers and individuals, who would no longer pay insurance company premiums, co-payments or deductibles. Medicare, Medi-Cal and other public monies spent on health care would be rolled into the fund.
"Our health care system in California is very fragmented and grossly ineffective. There is more than enough money to provide every Californian with benefit-rich health coverage without spending any more money," said Kuehl, speaking March 18 at an event hosted by Zay Gezunt, The Jewish Coalition for Healthcare for All, sponsored by the Workmen's Circle/Arbeter Ring, Progressive Jewish Alliance, The Sholem Community, Health Care for All, Jewish Labor Committee, The National Council of Jewish Women -- Los Angeles, The Kalsman Institute on Judaism and Health HUC-JIR, Kehillat Israel, Society for Humanistic Judaism -- Los Angeles, Jewish Reconstructionist Federation and Leo Baeck Temple.
"We spend about $150 billion per year on health care in California.... No new spending would be required to cover everyone if we get administrative costs down," Kuehl said.
Kuehl's office estimates that there are more than 10,000 health benefit plans in California. And a study by Harvard researchers, reported in The New England Journal of Medicine, found that administrative costs acounted for 31 percent of health care expenditures in the United States.
Proponents of SB 921 say consolidation of administrative costs alone would save an estimated $14 billion in the plan's first year. They also project a savings of $4 billion in prescription drug and durable medical equipment costs, which would be generated by the state's bulk purchasing power. Further savings are anticipated from a decrease in emergency room visits, which would be curtailed once uninsured individuals had access to preventive care.
Kuehl points out that other countries with universal health care systems have better health outcomes. For example, the United States is ranked 37th in health outcomes and consumer satisfaction by the World Health Organization, despite spending more than $4,000 per person -- more than any other nation -- on health care annually. No. 1 ranked France spends about half that amount.
"This approach has some real legs," said presenter E. Richard Brown, director of the UCLA Center for Health Policy Research, speaking at the health care forum. He believes the bill represents "the opportunity to make some real change in this state and set a model for the United States."
Not everyone agrees.
"To someone who hasn't been in health care or administered health care programs, it sounds attractive, but I've never yet seen a case where the government can run any health care service successfully," said Dr. Joel Strom, a dentist and the president of the Los Angeles chapter of the Republican Jewish Coalition. "After years of participating in the paper-filled and heavily regulated state-run Denti-Cal program, I elected to deliver free care to some patients rather than continue in the heavily regulated program. When you have a program that's paid for by the government, they'll go back to taxpayers all the time.
"The promise of unlimited health care for everyone just cannot be kept," added Strom, who sees insurance reform as a preferable option.
In the meantime, the Legislature has passed SB 2, a bill phasing in requirements for employers with more than 50 employees to provide health insurance or pay into a fund to finance it. However, a November ballot initiative seeks to repeal the new law before it has a chance to go into effect.
Kuehl's bill faces a formidable set of obstacles, including the requirement of a two-thirds vote for passage. It has a natural opponent in the health insurance industry, which is well-financed to fight the bill. In addition, Anthony Wright, executive director of advocacy group Health Access, notes that the notion of a tax could prove problematic. "Even though people will save money ... opponents of health reform will demonize it as a tax increase," he said.
While experts on both sides agree it is unlikely that the bill will pass this year, supporters remain optimistic.
As Kuehl staffer Emily Gold told The Journal, "It will pass. It's just a matter of when.... Its time is coming."