Health care showdown in CA--Over what?

On December 31, 2006, the health insurance I purchase through a group for freelance artists and writers cost me $4715/year. On January 1, it jumped to $12,268. That's $1.40 per hour. I watch a Dodgers game, and I'm down $3.50 by the 7th inning. I go to sleep, and I've paid another $11.20 for health insurance by the time I wake up.

Like so many people in California, then, I've been watching with high hopes this year as the Democratic legislature and the Republican governor both try mightily to pass a health-care reform bill. This is California, after all--the state that's decided to unilaterally stop global warming. The state that brought you emissions inspections on automobiles and no smoking in restaurants. We aim for the sky and the stars. We love to pave the way.

The bad news, of course, is that Schwarzenegger and the legislature have proposed moderately different plans, and are battling fiercely to prevent passage of the other. The worse news, unfortunately, is that both plans fail miserably to tackle two major causes of the health care crisis--the link between insurance and employment, and the central management role for private insurers, which maximize profits most efficiently by minimizing health care.

The competing plans aren't worth a seed-spitting contest, much less the raging foot-stomping political brawl.

California, rather, seems to be dead-set on showing the rest of the country how to keep us all in a state of mass anxiety about how to get and pay for health care. The governor and the Democrats are duking it out over how, exactly, to deny Americans the basic right to affordable health care that other developed countries in the world (all of them, actually) guarantee.

The centerpiece of both plans is that employers are required to spend a minimum percentage of their payroll to cover their workers--4% in Schwarzenegger's plan, and a decidedly massive 7.5% in the other. Surprisingly, the governor's plan mandates that every state resident has to buy insurance, while the Democrats' does not--though to be fair, the Dems resorted to this plan only because the governor vetoed their single-payer plan last year. Both sides propose to control the cost of premiums, and to prohibit denial of coverage even to Californians who have shown the bad judgment to acquire health problems. Neither plan, however, imposes clear-cut restrictions on the rates insurers can charge, nor do they regulate closely the exclusions, deductibles, and other provisions that determine extent of coverage. So it's a very good thing that both plans propose to subsidize poor residents, since the declining number of Americans who are neither poor nor rich (remember them?) will likely continue to be saddled with insurance rates and medical bills that can readily make them impoverished enough to qualify.

Essentially, the competing plans both add moderate regulations to a system that a majority of Americans say is radically broken. Both strengthen, rather than sever, the reliance on employers that's an accidental artifact of the post-World-War-II economy, when companies started to use health coverage to compete for workers. California's leaders are showing us show how to perpetuate the problems that Americans have reaped in the ensuing decades by deploying this policy on a mass scale. The employer-based plans restrict career choices and discourage self-employment. They burden small and lower-profit businesses, especially. And any American who becomes too sick to work loses coverage at exactly the moment when he or she most desperately requires health care.

By keeping decisions and profits in the hands of private insurers, the Golden State also aims to show us how this country can continue to tie up the costs of health care in the earnings of hugely profitable companies--such as CIGNA, my insurer, which made $1.63 billion in 2005 and earned a 37% return for shareholders. Which paid its CEO $28.8 million--$54.83/minute, and 6117 premiums at my 2005 rate. And which does not bother to mention health care provision in the eight criteria the Board of Directors has developed to assess CEO performance--nor in its self-described purpose as a company "that focuses on our control environment, risk management and shareholder return." I can't say what "control environment" is, exactly--but I'm pretty sure it's not health care.

Yes, California will lead the way to leave the management of Americansí health care in these companiesí hands, since, as Assembly Speaker Fabian NuŮez has declared this year, "We're not trying to turn this state into Cuba...or Canada." They'll show us how not to do something so un-American as prioritizing the health of many over the profits of a few, which is a priority that every other prosperous democracy embraces. They'll patriotically lead the charge to support a free-market health care economy that increasingly has stripped Americans of the basic everyday freedoms of deciding what careers they can pursue, and whether they can move to another town or state, and even how many children they can realistically think about being able to afford.

In sum, California's political leaders, who are pioneering the way to global re-cooling, are inexplicably and pusillanimously leading the way toward health care reform that will use modest regulations to cover more people and provide moderate cost reductions. And it energetically preserves a system in which the extreme difficulty of getting and paying for health care will undemocratically restrict the most essential choices in our lives, and will remain an omnipresent source of anxiety.

Or to put it another way--A night of sleep in California might soon cost slightly less than $11.40. However, in any state that follows California's lead, a good night's sleep will continue to be exceptionally hard to get.

(A version of this piece appeared on the Huffington Post Blog)


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