California Healthcare Recipes Could Whet National Appetite
In Washington, the debate over reforming the healthcare system seems to be on life support. The capital has largely turned the other way as a spiral of rising prices and declining access has increased the number of uninsured nationwide by more than 5 million since 2000. Proposals now advancing from President Bush and GOP congressional leaders to cut spending on Medicaid, the joint state-federal healthcare program for the poor, would probably push those numbers higher yet.
All of which makes the ferment over healthcare in California so timely. Almost every conceivable idea to expand health coverage for the uninsured is on the table in the state. These include a mandate on employers to insure their workers, a mandate on individuals to purchase insurance, a single-payer government-run healthcare system that would eliminate private insurance and a public-private partnership to guarantee coverage for all children.
If the state could reach consensus on any of these approaches -- or, more likely, a blend of them -- that could inspire action in other states and eventually encourage Washington to return to the problem. "This has to get solved nationally," says Bruce Bodaken, the chairman and chief executive of Blue Shield of California. "But a single state solution, as an opportunity for other states and the federal government to look at what might work, makes a lot of sense."
The breadth of ideas surfacing in California underscores the depth of the problem. Figures from the Census Bureau and UCLA's Center for Health Policy Research show that about one-fifth of Californians lack health insurance. That's among the highest rates of any state. The number of Californians without health insurance (an estimated 6.6 million) exceeds the entire population of 38 states.
That translates not only into inadequate care for those without insurance, but also enormous financial pressure on public hospitals and clinics and higher bills for the insured, whose premiums must fund the care the uninsured do receive.
An unexpectedly close ballot brawl in November helped propel healthcare onto the state agenda. With a late assist from Gov. Arnold Schwarzenegger, business interests passed a ballot initiative to repeal the mandate that former Gov. Gray Davis signed requiring employers in firms with at least 50 workers to insure their employees.
