Title: Policy Perspective
Author:
Section/SPIG: Community Health Planning and Policy Development
Issue Date:
POLICY PERSPECTIVE
By John Steen
(This article first appeared in the American Health Planning Association Newsletter, 2003, and is printed here with permission)
Whenever I’ve taught health policy analysis, I’ve begun with the ever-remarkable fact that our nation doesn’t have a national health care system, and that in place of one, we have fifty state “systems.” In addition not being systems, which would imply that they were designed to be what they are, they are constantly changing. With the lack of insight and will on the national scene producing a political impasse on the prospect of our establishing one, grassroots organizations, business and professional organizations and unions, and a few farsighted leaders have set in motion state initiatives for universal health insurance. Each and every one of them, most recently in Oregon and Massachusetts, has proven the impossibility of any state’s performing such a feat on its own. Even before most of these recent state initiatives, Cook County, Illinois (Chicago) sought to do so as a memorial to the late Cardinal Bernadin whose lifelong advocacy inspired it, with the same result.
All previous efforts notwithstanding, we should take a fresh look at California. That state secured a HRSA State Planning Grant to fund its Health Care Options Project, a conceptually more ambitious attempt to universalize health care. The resulting report presented last September contained nine separate proposals outlining how the state could get there. Three are single payer plans and have features of interest to health planners. All nine plans may be viewed by going to <http://www.healthcareoptions.ca.gov/doclib.asp>.
“CAL CARE” SINGLE PAYER PROPOSAL (Spelman and Health Care for All-California)
Among the progressive features in this plan are all the right incentives and none of the wrong ones – the moral antithesis of what we have now! There is a rich set of services including increased investment in health planning, prevention, and health education. That would translate into support for public health approaches to population health improvement, and public access to performance information. Regional boards of stakeholders, a health officer, and an office for consumer advocacy would be established in each county.
All this without any co-pays, too! This plan demonstrates the ability of single payer plans to realize cost savings through the reduction of administrative expenses. A Lewin Group analysis concluded that it could reduce insurer administrative costs by $6.6 billion, physician administrative costs by $5.2 billion, and hospital administrative costs by $2.3 billion. The total savings of $14.1 billion would be more than sufficient to fund the plan, and would even result in a net savings to the state of $3.7 billion in 2002.
CALIFORNIA HEALTH SERVICE PLAN (Shaffer)
Under this single payer plan, the state would be the sole employer as well as payer for the health care delivery system. State and local health departments would be funded for health planning, including the setting of quality targets and strategic planning to improve population health status. Health care workers and communities would be involved in planning and decision-making.
SINGLE PAYER HEALTH PROGRAM FOR CALIFORNIA (Kahn, Bodenheimer, Farey, Lingappa, and McCanne)
This plan is designed more from a physician perspective, and achieves single payer status with fewer alterations to the current landscape of service providers. It supports public health and prevention through earmarked funding, but it has some small co-pays (not for prevention). A uniquely progressive feature is its administration through not just an elected state health commissioner and a public state board, but also by regional boards that include providers, employers and consumers. In addition, there would be advisory groups for such issues as quality assurance, clinical guidelines and immigrant access.
It can surely be seen as ironic that so intelligent a set of public policy proposals are now being considered in the state least able to afford them by accepted ways of voter thinking, but that is the ace-in-the-hole for single payer plans that are self-financing. And anyway, we’ve long been saying that things would have to get a lot worse before they could get better, haven’t we? It has to be clearer in California than in any other state that they are on their own in dealing with their monumental state finance problems; no assistance can be expected from a hostile Bush Administration. It used to be said too that whatever was going to happen would happen first in California! We’ll see. The debate has been set. In February of this year, State Senator Sheila Kuehl introduced Senate Bill No. SB 921 patterned after these single payer proposals.