The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

To Legislate or Not to Legislate. That is the Question

Posted by Alan on October 7, 2007

To legislate or not to legislate. That is the question.

OK. It’s not really the question. Everyone seems to want to legislate, so a better question is whether they can or not. Governor Arnold Schwarzenegger’s and others labored through this weekend working toward a compromise that: 1) makes the current health care system better (at least in their view); 2) can earn the vote of a majority of Legislators; and 3) can get signed by the Governor. The endless meetings, sharing of drafts, eternal discussions, and shaping of legislative language constitute the nuts and bolts of legislation. It’s not flashy and it’s not fun, but ultimately it’s what moves legislation forward.

Will their efforts be enough? In today (Sunday’s) San Francisco Chronicle, Tom Chorneau writes that time is running out for health care reform this year.  He quotes Jan Emerson of the California Hospital Association as saying “It’s hard to tell how all this is going to play out. I think there’s still a lot of momentum, and people are still working very hard.”

According to those quoted in Mr. Chorneau’s column, the biggest obstacle remains the Governor’s insistence that all individuals obtain health care coverage and lawmakers differing approaches to making health insurance affordable — especially if Californians are mandated to buy it. Another stumbling block is how to finance the reform package.

There are a several dynamics which indicate against achieving a compromise. According to the Chronicle, the current special session is scheduled to conclude next week. (It would be relatively straightforward to extend it, although keeping enough legislators around to accomplish anything could be a problem). The devil dwells in details and while the Governor has assembled a broad coalition in support of the principles underlying his reform package, it remains to be seen how enthusiastic his supporters will be with the language that eventually emerges. Then there’s the small matter of the differences between the Administration and Legislature being very real and not easily resolved. Both have constituencies pulling in opposite directions and they may not be able to bring them together in the middle.

On the plus side, there is a real desire among the principals and their staff to get something done. They sincerely believe in what they’re doing and are deeply committed to their goals. Better still, while desire to succeed is a good motivator, fear can be a better one, and there’s plenty of that to go around, too. If lawmakers had initially declared health care reform a two year effort, it might be different. Unfortunately, both the Governor and the Legislative Leadership have repeatedly announced otherwise. The political fallout of failure to meet this (unnecessary) deadline would be substantial — especially in the run-up to the initiative aimed at modifying the state’s term limit law on the February 2008 ballot.  Also arguing for a resolution is that a great deal has already been accomplished.

My personal take on all this is that no legislation will pass next week. There’s just too many details to iron out on too many issues. So I think the special session on health care will be extended and negotiations will continue for a few more weeks. By Halloween, however, (and how appropriate is that?) we’ll see something both sides can agree on. It will then take several days to assess reaction and determine if a critical mass of stakeholders support the consensus. If there is, a bill could be on the Governor’s desk by mid-November.  Of course, much of what’s in the bill will be contingent on the passage of a funding initiative on the November 2008 ballot, so passage of legislation is only the start of the reform effort. For now, however, all anyone can do is keep moving forward through the political and policy thicket and hope there’s a there there when they’re done. Because the question isn’t whether or not to legislate. It’s not even whether they can legislate. Responsible and workable reform is needed. So the real question is, not whether to legislate, but what to legislate.


One Response to “To Legislate or Not to Legislate. That is the Question”

  1. Nice update on the California reform proceedings. But that blog title sounds vaguely familiar. 🙂

    To Govern or Not to Govern: That is the Health Care Debate Question

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