I am a lifelong Democrat who has worked for more than a decade to improve the policies and build the coalitions necessary for the success of the Affordable Care Act. Even so, I believe the ACA didn’t go far enough to guarantee universal and affordable health coverage.
So why I am so hopping mad about the “single-payer” bill – SB 562 – making its way through California’s legislature?
My frustration is with how the bill exploits widespread confusion about good healthcare policy and how other countries achieve them. The bill’s proponents lead people to believe that only the United States has a profit-based system and everywhere else has a fully government-run system producing better care at lower cost. In truth, every industrialized country has a hybrid system and all are wrestling with the same challenges – especially healthcare costs.
But advocates press on, saying SB 562 will bring healthcare access to people who can’t afford it, that it is backed by all right-thinking Democrats. Poppycock.
If you care about people, you have to care about policy. And this proposal is very poorly designed and impossible to implement.
Those legislators who voted it out of the Senate ignored the spectacular work of the Senate Appropriations committee staff, who pointed out all the bill’s fatal flaws. In any sane world, that would have sent proponents back to the drawing board. Instead, it sent them to the barricades, denouncing anyone who might oppose it.
What are these flaws? Start with the bill’s illegality. It would take all of the healthcare money being spent through Medicare, Medicaid, the Veterans Administration and other programs and put it into one big pot then California would ask for waivers from federal laws so we could spend the money as we please. In fact, we could not.
States are temporarily allowed to waive certain requirements of Medicare and Medicaid to experiment with improving those programs. But these waivers do not allow states to do away with these programs entirely. It would take a change in federal law to make the basic financing scheme possible, and there are many other provisions that would violate other federal laws – such as prohibitions on state regulation of the health benefits of large employers.
This bill takes an enormous problem – rising healthcare costs – and makes it a runaway train. The Senate Appropriations Committee put the price tag at $400 billion, twice the size of the state budget. But as big as the initial spending would be, the long-term cost would be much greater.
The bill encourages people to consume more health care, adding to costs. The bill makes co-payments for doctor’s visits illegal. The initial draft proposed that only providers of medical care would determine what is medically necessary. The legislation is based on a fee-for-service system – doctors would get paid for every procedure. That would encouraging them to perform a higher number of procedures.
There is literally nothing we have learned about healthcare in the past century that this bill’s authors appear to understand.
Health care systems, especially government-run systems, require management. The system being proposed here is essentially unmanaged. No country or state could afford such a system, in which patients are encouraged to consume as much healthcare as they want and doctors are paid more for every additional service they perform.
One final frustration: the efforts of those who are truly committed to universal affordable healthcare are needed elsewhere. The American Health Care Act, now in the Senate, would take a buzzsaw to our efforts to create universal healthcare, wiping away the gains of the ACA but also handicapping (if not destroying) the Medicaid program for lower-income individuals.
The California legislature should devote all its attention to opposing the federal legislation, and saving Medicaid.
Instead, the legislature is wasting time on this nonsense. Californians should be united around real progress on healthcare reform, not scattered by divisive fantasies.