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Ready for its checkup

The governor's willingness to address California's broken healthcare system is encouraging.

January 02, 2007

GOV. ARNOLD Schwarzenegger has set the bar so high in promising healthcare reform that it's tempting to suspect that he broke his leg on purpose, just for the photo-op in his hospital bed to drive home the high costs of healthcare. Upon reelection eight weeks ago, the governor vowed to cut the number of California's uninsured in half. Since then, he has refused to retrench, hinting instead at plans to cover pretty much everyone in the state.

Schwarzenegger is right in noting that the current system needs improvement. Six million Californians are uninsured. Many of them want coverage but can't get it -- because they can't afford it, don't know where to find it or are ineligible for it. Everyone ends up paying for them because they seek treatment in emergency rooms, adding to the state's budget burden or to an estimated 10% "hidden tax" added to the insurance premiums of those who do have coverage.

Meanwhile, the health problems of the uninsured become everyone's in the form of communicable diseases and lost productivity. Some of the uninsured are healthy and simply choose not to spend their money on insurance. But everyone pays for their care when they get injured or fall ill.

In working through the options, Schwarzenegger would be wise to steer clear of new mandates on employers to provide health insurance for workers and their families. Voluntary employer-provided insurance is the most successful current way to distribute healthcare. But employer mandates would fail to reach many of the targeted uninsured, who are at best only marginally and transiently employed.

Other options are more intriguing. If every Californian were required to carry health insurance, either through work, the open market or (for those who need assistance) a government-subsidized program, patients would have an incentive to seek less costly preventive care. But insurance alone is not healthcare, and individual mandates can't by themselves stem costs.

Other solutions appear too utopian. A plan that provides healthcare to everyone in the state would be spectacularly costly. But so is having 6 million people without health insurance. And although it may cost more in the long run to leave illegal immigrants uninsured, insuring them would be an ambitious undertaking.

No health plan will be perfect because no health plan can simultaneously control costs, harness the power of the market and guarantee top-level treatment for everyone in the state. In the end, the cure for California's health problems probably should be found in Washington. But for the moment, the states are producing the most interesting and sweeping healthcare plans, and California can lead the way. Schwarzenegger deserves credit for taking on the issue. We hope he won't take it the wrong way when we offer this hope for the unveiling of his proposal next week in his State of the State address:

Break a leg.

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