The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

California Health Care Reform: Not Enough Corners to Go Around

Posted by Alan on October 26, 2007

Is it just me or, when it comes to health care reform in California, is everyone staking out uncomfortable positions? Because it looks to me we may be running out of corners for people to back themselves into.

For example, some labor unions and consumer groups are attacking Governor Arnold Schwarzenegger for proposing a health care reform package which requires individuals to purchase coverage from, among other sources, private insurers. Yet most of the leading Democratic presidential candidates are calling for the same thing. How will this approach suddenly become acceptable when it’s advocated by Hillary Clinton?

Several business organizations, medical associations, and carriers endorsed the Governor’s plan in principle back in September. To them, the key phrase is “in principle.” The reality is, however, once you’ve posed alongside the Governor for the cameras the details need to be pretty onerous to withdraw your support. Yet, there’s a decent possibility (although certainly not a certainty, to overuse a certain phrase) that, with the plan under attack from the left, the Governor will compromise in ways that could be pretty darn onerous to some of these folks. Onerous enough to walk away from the post powerful public official in the state? And what will they do with those pictures hanging on their wall if it comes down to this?

Meanwhile, Assembly Speaker Fabian Nunez and Senate President Pro Temp Don Perata have committed to both pushing the agenda of their supporters (most notably their union allies) and to producing a comprehensive reform package that can be signed into law — preferably before the February vote on the term limits initiative. If they move too far toward the Governor’s position they’ll fail to satisfy their supporters. Yet  if they don’t move a fair distance toward the Governor’s position nothing will pass. There are Auntie Anne’s pretzel’s twisted into more comfortable positions than these guys.

The Republican Leadership isn’t exempt from the rush to the corners. Their principles prevent them from supporting new spending. Bringing any significant number of the uninsured into the health care coverage system — which most people consider to be one of the main goals of health care reform — will require new spending. This means Republican lawmakers have boxed themselves out of negotiations altogether.

Even Governor Schwarzenegger has managed to find a corner of his own. He declared 2007 the year of health care reform way back in 2006. He has consistently declared California’s health care system as broken. Consistently as in weekly for nearly a year. Consistently as in changing the title of his health care reform site from “Stay Healthy California” to “Fixing Our Broken Health Care System.” Now that he’s convinced Californians the system is broken, he needs to show he can fix it. He’s said the key to this is personal responsibility (requiring individuals to buy coverage) and shared pain (meaning everyone pays for reforms, not just business). Considering these keys are the primary points of contention with Democrats it’s going to be interesting to see how he fixes health care without walking away from his principles.

Of course there’s ways out of all these corners. The simpliest method is to declare failure the “other guys” fault and then sponsor a ballot initiative to achieve your vision of reform. This is basic stuff, taught by both parties in Politics 101. By the time you reach this level of politics, spinning out of tight political spots is just another day at the office.

So I’m not predicting folks will stay backed into their corners. I just find it fascinating that virtually every actor in the health care reform drama seems to be occupying one.


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