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Spyros Andreopoulos, director emeritus of the Office of Communication
and Public Affairs at Stanford University Medical Center,
The San Francisco Chronicle
Wednesday, September 22, 2004
Health care costs, rising five times faster than the rate of inflation and
dragging down our economy, are in the headlines again. The causes are
runaway administrative costs, waste, excessive drug prices, medical
technologies out of control, arbitrary changes in insurance coverage by
employers without relation to employee needs and moves to undermine
doctors' responsibility and judgment.
Take a look at our Democratic and Republican presidential candidates.
Neither has presented us with a stark choice on health care nor offered
any way to make health care more affordable. Clearly, we cannot depend on
federal solutions for the foreseeable future.
There is a solution for a publicly financed universal system covering
every Californian at hand in Sacramento. Proposed legislation, SB921,
sponsored by Sen. Sheila Kuehl, D-Santa Monica, would establish a single
state government fund to pay hospitals, doctors and other providers, and
replace the current multiplayer wasteful system of private insurers. A
unique feature of the legislation is that all health risks are placed in
single universal risk pool. The principle behind insurance is to spread
individual risks across a group in which the premiums paid by those with
better than average health go to cover the costs of those with worse
health. The larger and more diverse the risk pool is, the lower the cost
of insurance.
The plan, designed to support care of high quality, would require no new
state spending. Combining federal, state and county monies already spent
on health care, and replacing insurance premiums with an affordable state
health- care tax, would finance the new system.
The scheme would reduce administrative costs and address inefficiency from
poor planning and allocation of resources across different parts of the
system. One example is the need to revive the training of primary-care
physicians in the state and to stop the inappropriate use of expensive
hospital emergency departments for routine care. Another is to remove
incentives that encourage over-consumption and duplication of facilities
contributing to high costs.
Under the proposed law, medical services would be provided by the existing
private health-care delivery system. All Californians would return to free
choice of doctors and hospitals, not just choice of restrictive health-
care plans. Doctors and other health-care providers would have a direct
voice in the policy boards that establish coverage guidelines and
health-care standards. And California employers would be relieved of
administrative hassles and expenses of maintaining health-insurance
benefit programs, a practice many businesses now say they can no longer
afford and which are resulting in costly labor strikes across the state.
Another benefit is that the new system would enable the state to negotiate
drug prices the way Canadian provinces and even our own U.S. Department of
Veterans Affairs (VA) system do now as bulk purchasers. Interestingly,
such a provision should also have been included in the new Medicare drug
prescription law, but pharmaceutical industry lobbyists made certain to
bar Medicare from negotiating drug prices.
In June, SB921 passed, 12 to 5, in the Assembly Health Committee, paving
the way for a comprehensive health-reform solution. The bill has more than
400 endorsements from California organizations. Proponents hope that its
chances of advancing to final legislation have increased but not for this
year or the next. But if our health-care crisis is as serious as
portrayed, why not sooner? What political obstacles are in the way?
The key obstacle is the voters. Most voters, according to one school of
thought, are indifferent to the need for health-policy change as long as
their employers pay the bills, they are healthy and have little or no
exposure to the medical system. The sick, however, do care. And, as Dr.
Jeffrey Burack of UC Berkeley points out it in an article in the New
England Journal of Medicine, we all need to be aware that we will get sick
at some point in our lives, and this requires "promoting a sense of
responsibility on the part of the healthy majority for the needs of the
ill minority."
Proponents of SB921 need to heed this advice. Their message, if they want
public support for their cause to grow, must convey why California cannot
afford a catastrophe resulting in deteriorating medical care and why the
state must proceed alone, as the Institute of Medicine, the nation's
adviser on health, has recommended for states to do, without expecting a
national solution.
Neither presidential candidate has presented us with a solution on health
care. Sen. John Kerry would like Americans to join something like the
Federal Employees Health Benefit Program, which covers 9 million federal
employees and their dependents, but he has not provided convincing numbers
about how he will pay for it. President Bush supports tax credits of up to
$1,000 to entice workers to buy private insurance, but most economists
believe it is unlikely many workers will abandon their employer-based
system. Bush's other fixation - - affordable health insurance for small
businesses through trade associations -- is also a loser. Small businesses
can do this now and find they cannot afford it.
Bush and Kerry differ over how to bring down health-care costs. The
president favors capping medical malpractice lawsuits as if they were the
main culprit. Kerry opposes such caps. Kerry wants to allow Americans to
import low- cost prescription drugs from Canada. Bush has rejected the
idea.
The two candidates disagree on Medicare's overhaul. Bush has offered
Medicare beneficiaries a discount card that will serve to bridge a broader
prescription-drug benefit starting in 2006. Many seniors have found the
discount card of little use at the present rate of inflation of drug
prices. Kerry opposed the measure.
Federal solutions to this national dilemma are unlikely to arise because
influence purchased by the insurance industry through political
contributions jeopardizes policy initiatives in national health-care
reform. At the state level, on the other hand, an aroused public could
overcome the special interests. If California voters are convinced that
the marketplace on which we had pinned our hopes for solutions is no
longer -- if it ever were -- adequate for a system of medical care, and if
they consider what the special interests tell them and compare it to their
personal experiences, they will move the political process.
E-mail Sen. Sheila Kuehl at Sheila.Kuehl@sen.ca.gov to share your views on
SB921.
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