Healthy Skepticism

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The first thing to notice about Governor Schwarzenegger's plan, which is being billed as a universal healthcare plan, is that it isn't a universal healthcare plan. It's a mandatory health insurance plan. It will not make sure a sick person gets the treatment he or she needs-- the treatments, drugs, doctors and hospitals, an insurance carrier or HMO are willing to pay for are still left up to the corporation the person buys insurance from. Anyone who has spent hours on the phone with an insurance company trying to get approval for a needed drug or procedure knows that healthcare and health insurance are not quite the same thing.

(One basic aspect of the governor's plan for mandatory insurance, and the Massachusetts plan it is modeled on, has always struck me as curious. Can anyone think of any other circumstance in which a citizen, simply as a requirement of living in a particular state, is required to pay to a private corporation for its services or face state-levied penalties? The analogy that's made is usually driving and auto insurance-- if you're going to drive, you must have insurance-- but even in California, driving is still just an option. You can choose to do it or not. Just breathing, on the other hand, is the condition that triggers the requirement for health insurance.)

Opposition is already lining up against the governor's plan. That's not surprising. Compromises will have to be made. That's to be expected. Unfortunately, as Jordan Rau points out in an analysis in the Los Angeles Times, the results of compromise in this case may prove fatal.

All of the plan's details can be altered and its questions can be resolved in negotiations with lawmakers, and Schwarzenegger said he looked forward to forging a bipartisan agreement as he had last year with a massive public works building project.

But because so many parts of Schwarzenegger's plan hinge on one another, deleting the areas of greatest disagreement could unravel the entire plan.

"Health insurance reform is as delicate as an egg," said Jamie Court, president of the Foundation of Taxpayer and Consumer Rights, a Santa-Monica based watchdog group. "One little crack and the egg is lost."

And as Dan Walters explains in the Sacramento Bee, the state legislature excels at cracking eggs.

The overarching uncertainty, however, is whether such an ambitious scheme could survive the legislative grinder, where interest groups will exert their influence to gain financially advantageous changes for their members. Consumer groups will oppose the individual coverage mandates, for instance, while many employers will oppose being required to provide coverage (those with under 10 workers would be exempted) or pay in-lieu taxes.

A big question is whether the proposed taxes -- about $4.5 billion of the $12 billion -- would require two-thirds legislative votes, which would give a veto to anti-tax Republican legislators and perhaps sink the scheme. Administration officials and Democratic leaders hope to avoid the two-thirds vote by calling the taxes fees, but if they do that, the courts would have the last word.

Health care looms as another huge test for a political system that has, for the most part, failed to address California's pressing policy issues. There are four possibilities: effectively reforming health care, enacting a minor, face-saving expansion of care, another gridlock failure, or creating another unworkable monstrosity.

My guess is that it'll be gridlock followed by a minor, face-saving expansion, containing flaws that will eventually threaten to turn the system into an unworkable monstrosity. But then again, I'm an optimist. (Experts in psychoendoneuroimmunology believe that an optimistic attitude can help you maintain good heath. So buck up-- because a positive attitude may be the only form of health care to which you have guaranteed access.)

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