The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

California Health Care Reform Debate: Lesson for the Nation?

Posted by Alan on December 30, 2007

California enjoy their image of national trendsetters. Advocates on all sides of the health care reform debate in California are fond of claiming that what happens here will set in motion a reform movement that will alter the course of the presidential primaries and health care of the country.

I’m not so sure the specific elements of the health care reform package, passed by the assembly and to be taken up by the State Senate, is really going to alter the debate. Heck, I’m not sure it will even pass the State Senate. Assuming it does, what’s the lesson of Assembly Bill X1-1? That purchasing pools are the solution? They’ve been around, and failing, for over a decade. That $1.75 is the appropriate amount for a cigarette tax increase? That carriers must accept all applicants? That too has been around, and increasing premiums, for years. Tying guarantee issue of products to a requirement that all residents have coverage might be the element of ABX1-1 that most qualifies it as a model for the rest of the nation.  But I think the lesson California has to offer is more one of process than specifics. And the lesson is the need for a less partisan approach to the effort.

Health care touches everyone. It’s more than a political issue, it’s a deeply personal one. At the same time it has a tremendous impact on the big picture. It’s over 15 percent of the nation’s economy. It affects the fiscal stability of government, the competitiveness of businesses, and the financial security of families. There are few issues that influences both society and everyday lives as much as health care. Consequently, there are few issues with so many stakeholders as health care.

Getting buy-in for a health care reform package is, not surprisingly, a challenge. Policy makers have two choices: ram a partisan “solution” down the throats of the opposition or engage in a dialogue with them.

The former is tempting. In many ways it’s easier because it’s more about politics than public policy. Which elements of your constituency needs what provisions? Cobble them all together and slam the package through.

A nonpartisan approach is much more painful. There’s still a heavy dose of politics involved, but the resulting package needs to be able to stand up to the rigors of questioning and debate from a broad spectrum. The package –in total — needs to have a good chance of actually working. And it’s more likely to because it reflects ideas and input from a variety of viewpoints. It’s a slower process than a partisan effort. It’s a frustrating process. But in the end, the results are usually better.

The California’s health care reform debate illustrate this point.

To the extent ABX1-1, the Health Care Security and Cost Reduction Act, has any chance of passing, it’s because technically it is a bi-partisan bill. Governor Arnold Schwarzenegger is, after all,  a Republican. Senate President Pro Tem Don Perata and Assembly Speaker Fabian Nunez are Democrats. If the Democratic Legislative Leaders had a soul mate in the Governor’s office, the bill would have looked far different. The views of the business community and others would probably not have been ignored, but they would have been much further from the center of the debate. If the result wasn’t a single-payer solution it probably would have looked a lot more like Assembly Bill 8, the reform package passed by the legislature last year during the regular session, than ABX1-1. And regardless of whether one supports ABX1-1 or not, it’s a much better piece of legislation than either AB 8 or Senate Bill 840, the single-payer bill.

So California serves as evidence of the benefits of a bi-partisan approach.

However, ABX1-1 is only technically bi-partisan. Republicans in the legislature have been totally absent from the deliberations. To a large extent, this was their own choice. By refusing to accept any new taxes they made themselves irrelevant to the process, except as an obstacle to a purely legislative solution. Without the two-thirds votes necessary to create new taxes the Governor and the Democratic Leadership are turning to the ballot to fund the $14 billion health care reform plan.

Leaving Governor Schwarzenegger as the only Republican in the room is not a good way to insert the perspective of the Republican party into the debate. Even he refers to himself as being “post-partisan” and few would suggest he speaks for the core beliefs of the GOP. As a result, key elements of the bill did not get the full benefit of a truly bi-partisan debate. Would this have eliminated problem areas in the bill, such as the unlevel playing field created in favor of the purchasing pool? That’s a question California “nearly non-partisan” process can’t answer.

The partisan versus non-partisan approach to health care reform is already a part of the presidential campaign debate, at least on the Democratic side. Senator Barack Obama believes in the wisdom of bi-partisanship. According to the Boston Globe,“To Obama, Democrats have been unable to make progress on core concerns like universal healthcare because of a selfish Beltway political culture that puts partisanship ahead of the national interest; electing Clinton, he said, would perpetuate the existing ‘Washington game with the same Washington players.’

“‘You know that we can’t afford four more years of the same divisive food fight in Washington that’s about scoring political points instead of solving problems – that’s about tearing your opponents down instead of lifting this country up,’ Obama said last week.”

Former-Senator John Edwards, however, champions a more partisan approach. “‘You better send a fighter [to Washington]’, he told voters Friday night in Davenport. But politicians are not his main targets: Special interests are the force that must be quelled.

“‘Corporate greed has infiltrated everything that is happening in this country,’ Edwards said.” Hardly an invitation for all sides to participate in the discussion.

This is where the California experience can educate the national debate — even if ABX1-1 never makes it past the Senate. It shows that even a “nearly bi-partisan” approach resulted in a better bill, one that had the best chance of any of the available alternatives to become law.


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