Why trust the state with your healthcare needs?
If you need more reasons to oppose a state takeover of health insurance in California — more than the fact that it would cost about $400 billion per year and make all existing private health care policies illegal — consider the mess that the state has made out of vaccine distribution.
Decision-making about where vaccines will be sent and who is eligible to receive them appears to have been driven more by politics than health. The ever-shifting rules have caused local government officials, business owners, union leaders, school district officials and countless individual Californians to seethe in frustration.
On February 17, Riverside County Supervisors Karen Spiegel and Jeff Hewitt wrote in the PressEnterprise that the per capita allocation of vaccines to the state’s 58 counties seemed to show that “some counties are more equal than others.”
At that point, Riverside County had received 320,525 vaccine doses, while neighboring San Diego County had received 703,200 doses. The supervisors wrote that even allowing for the differing populations, “Riverside County has been shorted a little more than 171,000 doses.” Spiegel and Hewitt bashed the “botched response from the state,” which they said was “putting allies of the Sacramento administration ahead of ordinary Californians.”
The shortfall of vaccine doses was particularly frustrating to growers in Coachella and the eastern Coachella Valley, who had pressured local and state officials for months in their effort to get farmworkers protected and immunized from COVID-19. As early as April 28, Growing Coachella Valley, an organization of farmers in the area, wrote to a list of local and state representatives and bureaucrats seeking answers to unanswered questions. “We are operating our businesses to provide food for the shelves while running the risk of so many unknowns,” wrote Janell Percy, executive director of the group. The letter, like the questions, was unanswered.
When vaccines became available, Growing Coachella Valley was responsible for organizing what the New York Times said was “considered a model for how to administer vaccines to this population [farmworkers].” The growers provided and set up the vaccination sites, registered employees and gave the count to the county for delivery of doses. Then they watched as local and state politicians showed up for photo ops and gave most of the credit to community-based organizations (CBOs) that had little involvement.
One local politician, speaking at a vaccination event in front of cameras, minimized the growers’ effort as “making their buildings available,” while effusively praising the work of community-based organizations such as TODEC, a non-profit that provides legal aid.
“If it was because of CBOs, it would be happening everywhere,” one grower observed.
But it certainly was not happening everywhere. When Gov. Gavin Newsom visited a Coachella pop-up vaccination site on February 17, he said, “What this county has done no other county in the state had done. We need to replicate this program all up and down the state of California.”
To actually replicate the program, the Newsom administration would have had to provide vaccine doses earmarked for employer-organized vaccination sites. Instead, Newsom announced on February 26 that he was sending $52.7 million to 337 community-based organizations to help with vaccine outreach and education.
Is that medicine or politics? It’s true that outreach and education may help to calm fears, but it isn’t vaccine hesitancy that’s holding up vaccinations right now, it’s the limited availability of doses. Why spend money funding community-based organizations to persuade people to trust the vaccines when there are more than enough people urgently demanding the vaccines, and the money could be spent setting up more locations and paying health workers?
COVID-19 may be providing a convenient cover for political patronage. If the governor’s primary goal was to speed vaccinations to vulnerable people, the logical approach would be to replicate a system that works, not insert new layers of organizational bureaucracy between the vaccines and the arms. On the other hand, if the goal is political, then funding and empowering communitybased organizations to engage in outreach and register farmworkers for vaccinations happens to be remarkably similar to political organizing.
On March 4, Newsom announced that California will start sending 40 percent of all vaccine doses to 400 zip codes considered most vulnerable to COVID because of household income, education level and access to health care, an entirely new set of vaccination distribution rules based on “equity metrics.”
Medicine or politics? You be the judge.
If you don’t want to be your own judge, maybe you’d like to be your own doctor. The latest proposal for a state singlepayer health care system, Assembly Bill 1400, would abolish all current private health insurance policies in California and replace them with “CalCare.” The cost of a similar proposal in 2017 was estimated at $400 billion per year. For comparison, the entire state budget for 2021-22 is about $227 billion. As there would never be enough money to pay for CalCare, it’s likely that medical services would gradually become less accessible. That has already happened with Medi-Cal, as providers limit the number of Medi-Cal enrollees they will accept as patients.
That’s the path to a California in which people who need medical services have to call a politician for help, just as groups today are calling politicians to try to get vaccines. Unavoidably, if politicians make decisions affecting the practice of medicine, the practice of medicine will be dominated by politics.
That’s enough to make anyone sick.