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Equal Care for All, or Roll-the-Dice Care for Most?

This year corporate employers are pushing government to take up “health reform,” largely because they see health care as a significant obstacle to profits.  Will health reform happen, and will it be an advance or a take-away for most working people?

Take a look at California.  Governor Arnold Schwarzenegger proposed near-universal healthcare early in January.  Top Democrats immediately praised it as a good start.

Schwarzenegger would use the magnificent power of the state to tell every Californian that you must buy a health plan.  He doesn’t care much what the plan gives you — he just wants you to have a health card, so he can say everyone has health care.

This is universal contingent health care.

Democrats Eager to Work with Schwarzenegger

Democratic speaker of the state assembly Fabian Nunez called Schwarzenegger’s plan “good work” and “a good start” (Los Angeles Times, Jan. 9).  Democratic senate president Don Perata welcomed the fact that Schwarzenegger’s plan has something “for everyone to hate,” because that is a sign of a good compromise (San Francisco Chronicle, Jan. 9)

They are all ganging up on the populace.  Schwarzenegger is for “requiring all individuals to have a minimum level of coverage.”  He insists that “everyone present a coverage card at the point of service,” a card it is your responsibility to buy.  This country still has a law that if you show up at an emergency room, you get treated, but the Schwarzenegger mandate would empower hospitals and doctors to turn you away if you do not have a card, or at least it helps them justify delays in your care, evading responsibility for the medical outcome.

Some health cards will provide real security of care.  The well-to-do will have them.  For the masses, as far as Schwarzenegger is concerned, a valid health plan can sock you with spending out of your own pocket up to $10,000 for a family (presumably, per year).  The governor’s proposal boasts that such plans are available for $200 a month for a couple.  See, it’s affordable — if you read a lot of fine print.  Before you get injured or ill, then make sure your body’s need for care stays in bounds.

We will not go through a tedious description of the many patchwork programs in Schwarzenegger’s proposal that help the poor buy a health insurance card, modify Medi-Cal (the state’s version of Medicaid), and set up a new state purchasing pool.  The overall thrust is to file people into a number of fiscal and bureaucratic slots, the very opposite of equal care for all.

Social Democrats Get Behind Non-Single Payer Plan

What about progressive health reform activists?  Some would call them “pwogwessives,” but it gets painful to keep pursing the lips on that word.  Let’s just call them social democrats, an old-fashioned but deserved term of pejorative clarification.  For several years the social democrats have backed legislation by state senator Sheila Kuehl.  She usually avoids calling her “Health Insurance Reliability Act” a single payer plan, but the social democrats cheerfully give it that label.  Problem is, the proposal, running 90-plus pages, is not a universal plan of equal care for all.

What does “single payer” mean?  Fundamentally, it breaks the tie between paying for health care and getting it.  You get the care you need, and you get the same care whether you are a CEO or a janitor.  You do not pay a premium in order to get care, and you do not pay individually for pieces of care.  The part of Medicare funded by general revenues is an example of single payer; the part that requires a senior to pay a premium to ensure care is an exception.

A single payer plan is not much good unless it is comprehensive: almost all people should get almost all their health care through the single plan.  Last year this writer had the task of drafting a legislative criterion of comprehensiveness: when spending on health care outside the plan rises above 5% of all spending on health care, the law should automatically require expansion of the single payer system to get exception spending back below 5%.  This suggestion was duly submitted.  The policy experts at the state legislature changed a couple of words, and Senator Kuehl’s proposal, SB 840, said:

“The commissioner shall adjust the health insurance system budget so that aggregate spending in the state on health care outside of the system shall not exceed spending under this division by more than 5 percent.”

In other words, for $100 flowing through the so-called single payer plan, $105 can go outside the plan.  This so-called single payer legislation formalizes a requirement that its plan encompass less than half of all health care.  It is an insult to the concept.

SB 840 also allows a “temporary decrease in benefits” if the State declares it has a financial problem.  And copays and deductibles.  It is an ornate, over-specified proposal, watered down even before the political fighting begins.  For a contrast, take a look at congressman John ConyersHR 676.  It’s shorter, simpler, and most important, true to the single payer vision.

The well-meaning social democratic leadership of groups like Health Care for All-California and its OneCareNow campaign, a number of Wellstone Democratic clubs, and the state League of Women Voters convinced themselves that they can bring together all the “stakeholders,” that is, both working people and corporate power, and show them the wonders of universal health care for everyone.  Schwarzenegger is proving them correct.  His universal contingent health care has a good chance to become reality in California, with legislators’ help.

Something similar happened in Massachusetts last year, where Democrats from Ted Kennedy down passed Republican governor Romney’s individual mandate requiring that you buy health insurance from private insurers or a miserable state pool.  Social democrats in the Bay State largely kept quiet until after the Romney plan became law.

In reality, these corporate reforms compel every family to roll the dice.  Maybe a plan will cover what you turn out to need, maybe not.  Maybe you will face the choice of going into debt and spiraling into bankruptcy versus postponing care in the hope that your body will heal itself.

A Politics of Mass Prosperity

Criticism of Schwarzenegger’s proposal has been considerable and well deserved.  However, winning the policy debate in the eyes of an impartial observer is not the key.  By following behind Democratic legislators, single payer supporters are minimizing the strength they have to stop Schwarzenegger’s plan.  The legislators, including senator Kuehl, are eager to negotiate with the governor.  They will produce a monstrosity, something that gives corporate employers the financial relief they want.  It will likely makes things a little better for a tiny segment of the poor but worse for most working families.

We cannot bring all the stakeholders together, but we can demand and organize for Equal Care for All.  The atmosphere of the Schwarzenegger plan, like Bush’s Social Security reform, like the privatizing of public education, is that things can only get worse, and what happens is only a matter of how much less we must live with.  It is well known that the days of inspiring proposals to make capitalism attractive, days like the New Deal, are over.  It is less often observed that leaders who accept the limits imposed by corporate power are incapable of inspiring people with how things can be really better.  In the richest society in all of human history, we can and should have equal care for all, equal education for all, and equal security in employment and then retirement.

Equal care for all, or roll-the-dice care for most?  If health reform activists arouse people to embrace Equal Care for All as their right, they build more strength, not less, to limit the damage done by Schwarzenegger’s health reform.

But you would have to resign yourself to not being a player with the Democrats.


Charles Andrews is the author of Profit Fever: The Drive to Corporatize Health Care and How to Stop It (1995) and From Capitalism to Equality (2000).



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