In­flu­encers: To get health care for all in state will take time

The Fresno Bee (Sunday) - - Insight - BY DAN SCHNUR Spe­cial to The Bee

Note to read­ers: Each week through Novem­ber 2019, a se­lec­tion of our 101 Cal­i­for­nia In­flu­encers an­swers a ques­tion that is crit­i­cal to Cal­i­for­nia’s fu­ture. Top­ics in­clude ed­u­ca­tion, health­care, en­vi­ron­ment, hous­ing and eco­nomic growth.

Stay in the know: Go to www.fres­nobee.com/ in­flu­encers to sign up for the Cal­i­for­nia In­flu­encers news­let­ter – and tell us what you think.

There’s an old say­ing in politics: “You cam­paign in po­etry. You gov­ern in prose.”

Gavin New­som’s ap­proach to health care pol­icy re­flects this think­ing. New­som’s most am­bi­tious cam­paign prom­ise last year was to pro­vide health care to all Cal­i­for­ni­ans through a gov­ern­ment-run, sin­gle-payer sys­tem. But as the elec­tion drew closer, qual­i­fiers like “in­evitably” and “ul­ti­mately” be­gan to creep into his con­ver­sa­tion, sug­gest­ing a longer-term ef­fort would be nec­es­sary.

The Cal­i­for­nia In­flu­encers pre­scribe a sim­i­lar ap­proach to pro­vid­ing universal health care to the state’s res­i­dents. While they agree that achiev­ing 100 per­cent ac­cess should be the ul­ti­mate goal, most of them em­pha­sized a range of in­ter­me­di­ate mea­sures to move grad­u­ally closer to the tar­get.

“Next steps: ex­pand in­sur­ance pre­mium sub­si­dies for low-in­come fam­i­lies, es­tab­lish a statelevel in­di­vid­ual cov­er­age man­date and make cov­er­age avail­able to un­doc­u­mented in­di­vid­u­als,” said Carmela Coyle, pres­i­dent and CEO of the Cal­i­for­nia Hos­pi­tal As­so­ci­a­tion. “It’s time to fin­ish the job.”

State As­sem­bly Speaker An­thony Ren­don is one of sev­eral In­flu­encers who walk a line sim­i­lar to New­som’s.

“I ab­so­lutely be­lieve Cal­i­for­nia, and our na­tion as a whole, should make cer­tain that ev­ery per­son has ac­cess to qual­ity health care. It is one of the defin­ing chal­lenges of to­day,” said Ren­don, who has come un­der fire in the past for not sup­port­ing im­me­di­ate sin­gle-payer leg­is­la­tion while pushing for a more grad­ual ap­proach. “We have the build­ing blocks to trans­form our health care sys­tem and a path to take on a thought­ful ap­proach to­wards that goal.”

But words like “build­ing

blocks” and “path” are a red flag for more ag­gres­sive ad­vo­cates like Bon­nie Castillo, the Cal­i­for­ni­abased ex­ec­u­tive director of Na­tional Nurses United.

“Nurses ev­ery day care for peo­ple de­nied care due to cost, in­sur­ance re­stric­tions, and dis­par­i­ties cre­ated by a sys­tem premised on prof­its and abil­ity to pay, not pa­tient need. It’s in­hu­mane, and it must end,” Castillo said. “If our elected lead­ers be­lieve, as many pro­fess, that health care is a right, not a priv­i­lege, there’s only one solution, guar­an­teed care for ev­ery­one through… sin­gle payer/Medi­care for all.”

But most of the in­flu­encers rec­og­nized that in­cre­men­tal progress was the most plau­si­ble route to­ward more am­bi­tious ob­jec­tives.

“While I’m not a fan of chip­ping away at the prob­lem, I’ll rally be­hind any thought­ful ad­vance to make cov­er­age for all a re­al­ity,” said Sierra Health Foun­da­tion Pres­i­dent and CEO Chet Hewitt.

Cal­i­for­nia Health Ac­cess Ex­ec­u­tive Director An­thony Wright said he agreed with New­som’s plan for a “more ef­fi­cient, ef­fec­tive, and universal Medi­care for All-type sys­tem.”

“Com­ple­men­tary short­and long-term steps to a universal sys­tem will pro­vide health and eco­nomic ben­e­fits for not just the unin­sured, but their fam­i­lies and the com­mu­nity as a whole,” Wright said.

Other In­flu­encers say rein­ing in health care costs should be the higher pri­or­ity, sug­gest­ing more af­ford­able care would lead to in­creased ac­cess.

“Ac­cess to in­sur­ance does not mean ac­cess to care. It doesn’t mat­ter if you have an in­sur­ance card if you can’t get in to see a doc­tor or your co­pay is pro­hib­i­tively ex­pen­sive,” said state Assem­bly­woman Marie Wal­dron (R-Es­con­dido), who has pro­posed ways to re­duce bu­reau­cracy, in­crease com­pe­ti­tion and con­sumer choice, raise Medi-Cal provider rates, and cre­ate in­cen­tives for providers to work in ru­ral and un­der­served ar­eas.

Hoover Institutio­n Fel­low Lan­hee Chen agreed.

“The state has ex­panded cov­er­age over the last sev­eral years, but these gains will be un­sus­tain­able or ren­dered in­ef­fec­tive if additional changes aren’t made in a fis­cally pru­dent man­ner,” said Chen, a for­mer pol­icy director for Mitt Rom­ney’s 2012 pres­i­den­tial cam­paign. “More gov­ern­ment in­tru­sion into the health-care space… will only drive costs higher and make it harder for us to ex­pand ac­cess to cov­er­age for those who may need it.”

Cal­i­for­nia state Sen­a­tor Richard Pan (D-Sacra­mento) pointed out that more ef­fec­tive man­age­ment of chronic con­di­tions, which rep­re­sent the great ma­jor­ity of health care spending, would be a smarter way of re­duc­ing costs.

“Health plans should be com­pet­ing on value, not on which plan has the most fa­vor­able case mix,” Pan said. “Re­duc­tions in the growth in health care costs from im­prove­ments in chronic dis­eases man­age­ment in­clud­ing men­tal health care will help fund cov­er­age ex­pan­sions. In fact, ex­pand­ing cov­er­age may prove to be more cost ef­fec­tive than leav­ing peo­ple unin­sured.”

Robert Ross, pres­i­dent and CEO of The Cal­i­for­nia En­dow­ment, hinted that in­fight­ing should not get in the way of progress.

“(My col­leagues and I) are grow­ing in­creas­ingly ag­nos­tic about al­le­giance to a sin­gle right ap­proach,” Ross said. “Let’s just get ev­ery­body in the boat.”

RAN­DALL BEN­TON rben­[email protected]

Bob Hart of Ro­seville demon­strates dur­ing a rally in Sacra­mento in 2017, in sup­port of a Se­nate bill to cre­ate a universal sin­gle-payer health care sys­tem in Cal­i­for­nia.

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