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California and the West | CALIFORNIA ELECTIONS / U.S.

2 Approaches to Remedying Health Care

Feinstein and Campbell agree that improvements are needed, but she suggests relying on budget surpluses and he puts the emphasis on cost containment.


Opinion polls consistently reveal voter anxiety over the future of health care. Insurance is too expensive, HMOs are callous bean-counters and doctor waiting rooms are packed tighter than a jar of cotton swabs. Sure, the economy's good. Just don't get sick.

Against this backdrop, Sen. Dianne Feinstein and her opponent, Republican Rep. Tom Campbell, have put forth sweeping remedies for the sickly health care system. They say their plans will guarantee coverage to poor children, add drug-cost benefits for the elderly, and make things better for everyone in between.

Both plans are greater parts sugar pill than bitter medicine. But there are differences. While Feinstein relies on budget surpluses to support Medicare and other health care programs, Campbell appears to focus on cost containment.

"I do strongly support helping people in need," said Campbell, a moderate Republican from San Jose who remains far behind the Democratic incumbent in most polls. But he says something needs to be done to halt the hemorrhaging of Medicare dollars. He also advocates a "loser pays" system to deter frivolous lawsuits.

Campbell also strenuously opposes making the federal government "the only provider" of health care. Translation: No Hillary Rodham Clinton-style national health care.

A priority for Feinstein, the daughter and former wife of doctors, is a broad patients' bill of rights that will allow people to get the care they need without clearing every procedure with a bureaucrat in an office hundreds of miles away.

"It's extraordinarily difficult to sort it all out," she said of the medical quagmire in a recent stump speech in Oxnard. "All our health care facilities are in financial crisis: hospitals, nursing homes, home health agencies."

Seven million Californians are uninsured, including 2 million children. In the past four years, more than 40 hospitals have closed, and 64% are losing money, Feinstein said. Three hundred physician groups have gone bankrupt since 1996.

The same trends are evident in long-term care. About 12% of the 1,376 nursing homes in the state filed for bankruptcy in the last two years. Add to this the nursing shortage that has led to the recruitment of large numbers of foreign nurses.

"When my dad was chief of surgery at UC [San Francisco medical center] he had one secretary," Feinstein said. "He charged those who could afford to pay and not those who couldn't. I go to the doctor today and it's a frantic situation. Today, business is in medicine. It's a tragic element that my father and husband would roll over in their graves if they saw it."

On Labor Day, Feinstein broke her leg in a fall at her vacation home in Aspen, Colo. She was covered by her husband's private plan and was operated on by the doctor for the U.S. Olympic ski team.

The 67-year-old senator described her care as "top notch," but recognizes that most Californians, who have been herded into health maintenance organizations, are not so fortunate.

Feinstein blames a series of cost-control measures for many of the problems. California was the first state to go into managed care, and as a result premiums are lower here than in other states.

Second, the Balanced Budget Act of 1997 reduced payments to hospitals and home health care providers by $200 billion, much more than expected. Third, California has one of the lowest Medicare reimbursement rates in the nation.

All these things contributed to the failure of hospitals. Physician income has dropped by an average of $20,000 a year, Feinstein said, and that's why doctors are leaving the state, dropping California from eighth to 12th in the proportion of doctors to population.

To solve these problems, Feinstein advocates "add-back" amendments to the Balanced Budget Act to restore billions of dollars in payments to health care providers. She said Gov. Gray Davis' recent proposal to increase Medi-Cal payments by 10% is not enough. A 25% boost is needed to prevent more hospital closures.

To protect Medicare, she said, money should be set aside from the federal budget surplus after bailing out Social Security. Feinstein would also add prescription drug coverage to Medicare.

She does advocate Medicare reform. "I don't think millionaires should have full Medicare [benefits]," she said. "Above a certain level, people should pay the full cost of $5,500 rather than $460."

More must also be done to make sure that poor children are cared for properly, she said. Only about 50% of those eligible are enrolled in the Healthy Families program, which insures children for a maximum rate of $27 a month.

"We are still having children die from not being vaccinated for whooping cough. That's not acceptable," Feinstein said.

She would like to add coverage for parents, which would save money by curbing expensive visits to the emergency room by uninsured adults.

Finally, Feinstein supports the Norwood-Dingell Patients' Bill of Rights as a sword to hold over HMOs to force them to be more responsive to the ill.

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