The death of Calf health care reform

[Guest guest]

Weintraub: The death of health care reform

How Arnold Schwarzenegger's overhaul plan was doomed by the

Legislature's liberal-conservative partisan crossfire

Published 12:00 am PST Sunday, February 10, 2008

Story appeared in FORUM section, Page E4

The defeat last month of Gov. Arnold Schwarzenegger's proposal to

overhaul California's health care industry was a disappointing failure

for the governor on the one issue he had put at the top of his agenda

for an entire year. But the proposal's demise was also a vivid

confirmation of Schwarzenegger's diagnosis of what ails the

Legislature. The bill died in a partisan crossfire, opposed from the

beginning by conservative Republicans and ultimately killed by liberal

Democrats. It was a centrist approach in a Capitol where centrism has

become a dirty word.

The bill did not suffer from a lack of public support. Poll after poll

showed that Californians wanted the government to do more to expand

access to health care and to regulate the practices of private

insurance companies. The basic outline of the governor's plan – a

requirement that every Californian have insurance, with the costs

shared by employers, health care providers and individuals themselves

– attracted the support of 60 percent to 70 percent of those surveyed

by the Public Policy Institute of California in several polls taken

during 2007.

But it could not win a majority in a Legislature dominated by

ideological purists on the left and the right. Democrats in the

Legislature generally favor a single-payer program modeled after the

one in Canada, where private insurance is banned and the government

decides which benefits people will get and negotiates directly with

doctors and hospitals to determine how much they will be paid.

Republicans in the Legislature want to move in exactly the opposite

direction, reducing the regulation of health care and private

insurance while letting economic markets work more vigorously to

increase competition and bring down prices.

Schwarzenegger's plan did neither. Instead, it sought to preserve the

current mixed approach under which health care is provided by a

heavily regulated private industry with government subsidies for the poor.

A closed-door marathon

The real surprise is not that the governor's plan died in the Senate

but that it got as far as it did. When he proposed it a year ago,

parts of the plan were opposed by just about every interest group

involved in health care, and it did not have a single supporter in the

Legislature. But Schwarzenegger's aides convened a marathon of

closed-door sessions with stakeholders to work on the details of the

plan. Those meetings, while necessary and ultimately productive,

probably should have included a parallel series of public hearings

because without a public element, the evolution of the plan and its

ultimate configuration became something of a mystery to those who were

not following it closely.

The original proposal was based on Schwarzenegger's theory of " shared

responsibility. " Every person in California, he said, should be

required to have health insurance, and insurance companies should be

required to sell coverage to anyone who applied, regardless of the

applicant's health. Employers above a certain size would be required

to help their workers buy insurance or else pay a fee to the state,

with the money used to help uninsured workers afford coverage. The

final major element of the proposal was a tax on the revenues of

doctors and hospitals. That money would go to help expand coverage for

the poor in a way that would be matched by new payments from the

federal government.

Republican legislators universally condemned the mandates on

individuals and employers, the taxes and fees, and the new regulations

on insurance companies. And without Republican votes, it would be

impossible to achieve the two-thirds majorities required to enact a

tax increase in the Legislature. Eventually this fact forced

Schwarzenegger and the Legislature's Democratic leaders to split the

proposal in two. The guts of the program could move through the

Legislature with the votes of only Democrats, and the financing would

go on the ballot in the form of an initiative.

The solid wall of Republican opposition had another, less obvious

effect: It increased the Democrats' leverage over the governor. With

no chance of getting Republican votes, Schwarzenegger was forced to

rely entirely on the Democrats, which gave them more power to dictate

the shape of the final deal. And the Democrats, while they shared

Schwarzenegger's goal of expanding coverage through mandates and

subsidies, differed significantly on the specifics of how such a plan

would work.

http://www.sacbee.com/110/story/699348.html