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Give healthcare a chance

The state's plan, which passed the Assembly and could go before voters for funding, is worth the risk.

December 19, 2007

Apparently, Gov. Arnold Schwarzenegger spoke literally when he proclaimed in January that 2007 would be the "Year of Healthcare." It has taken nearly that long for the governor, Assembly Speaker Fabian Nunez (D-Los Angeles) and a motley assortment of policy wonks, labor groups and business advocates to hammer out the details of the Health Care Security and Cost Reduction Act, which on Monday finally passed in the Assembly on a 46-31 party-line vote. The plan is not perfect. Even its backers have admitted as much. But it is a worthwhile experiment.

Schwarzenegger's and Nunez's plan establishes an individual mandate, requiring every Californian to purchase insurance but assuring that coverage is available and affordable. There's plenty to like about it. Almost 4 million previously uninsured Californians would get coverage. The state would get access to $4 billion in federal funds that thus far it has left on the table. There would be new programs to promote preventive care and renewed efforts to rein in costs. Insurers would no longer be able to deny or rescind coverage when an individual is sick.

The problem? As usual, money. Schwarzenegger says the plan would pay for itself through contributions from business, policyholders and taxes on tobacco. But getting medical costs under control won't happen easily or quickly. There would be uncertainty. There may be unintended consequences. It may be difficult for some who just miss the cutoff for subsidies (an annual income of $82,600 for a family of four) to afford the mandate.

In a state about to enter a "fiscal state of emergency" because of a $14-billion budget shortfall, these concerns are nothing to sneeze at. But they shouldn't be a pretext to dismiss healthcare reform either.

For this bill to become law, it must pass the Senate, and voters must authorize funding through an as-yet-unseen initiative that the governor hopes to place on the November ballot. Senate President Pro Tem Don Perata (D-Oakland), who co-wrote the bill, has said the Senate will wait until mid-January to act. Some suggest that Perata is delaying a vote for political reasons. He says it's a matter of fiscal prudence -- that until the Senate sees the governor's plans for the budget, and the initiative language that details healthcare funding, he can't in good conscience pass the bill. That makes sense. But once the governor makes a reasonable case that there will be adequate funding -- and that there's a backup plan in place should finances fall short -- the Senate should get on board and let the signature collection begin.

No one is going to come up with the perfect solution to the state's healthcare woes. Opponents on the right cry out against any government boost for coverage or care. Opponents on the left dream of a single-payer, Medicare-like system for all. But the status quo is not tolerable. Given that this plan would not dismantle healthcare in California, why not give it a chance? It could help millions of people. As the "Year of Healthcare" draws to a close, it's time to take the blueprint for experimentation that we have and start figuring out, with the resources we have, how we might reasonably make it work.

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