Should California provide health care for everyone?

Some people believe it will take strong medicine to improve health care in California. And no stronger - or more controversial - medicine can be prescribed than universal health care.

While some envision a brave new world where health care is available to all, others fear the so-called "cure" might be worse than the disease. A tongue-in-cheek article in the San Jose Mercury News says the topic should be added to religion and politics as "off-limits for polite discussions with the in-laws."

"Gather any group of reasonable, intelligent Californians, ask whether the state should provide health care for everyone the way it provides education, and watch the fur fly. The debate usually ends up dominated by the two loudest voices, one shouting 'It's too extreme' and the other 'I'm moving to Canada,'" notes the article.

The debate will become loud and public in the near future with the introduction of legislation by state Senator Sheila Kuehl (D-23). The bill, which is still being written, is the result of a legislative mandate in 1999 to explore options for extending health coverage to all Californians. Kuehl recently shared her single-payer plan, called Cal Care, with CTA members attending CTA's Rural Issues Conference in Las Vegas. And teachers who heard what she had to say were very impressed, including CTA President-elect Barbara E. Kerr.

"She made a lot of sense," says Kerr. "I haven't read the whole bill, but at least someone is aware of the problem and trying to do something. Our folks at State Council will figure out whether or not it's the right way to go - and will decide whether CTA should support the bill or not."

"My bill would establish a single-payer system for all health services provided in California," says Kuehl, who also authored California's Family Leave Act. Hospitals and clinics would be placed on annual budgets for operations and capital expenditures, thus eliminating claims processing for these services. Other providers would be reimbursed on a fee-for-service basis according to a uniform billing system. Consumers could choose among all licensed health care providers in California. The plan would be administered by an independent health care agency headed by an elected health care commissioner.

The program would be administered through a state agency. Money that employers, individuals and businesses now send to insurance companies would go directly to the state. Theoretically, money would be saved by keeping administrative overhead at 3 percent - rather than the nearly 30 percent charged by insurance companies - and by negotiating big discount rates for pharmaceuticals and medical technology. The emphasis would be on preventative outpatient care rather than expensive inpatient care.

Critics say it could lead to yet another ineffective state bureaucracy and that the state, which faces the biggest deficit in history, is incapable of handling such a massive undertaking.

"My bill would provide a comprehensive benefit package including hospital, medical, mental health, dental, optical, prescription, dialysis, chiropractic, podiatric - with no exclusions," says Kuehl. "No one loses coverage because they lose their jobs or retire. It would leave clinical decision-making with providers and patients using global financing rather than an individual provider to control spending."

When asked at the Rural Issues Conference whether it might be too ambitious an undertaking, Kuehl responded, "Things are very bad right now. And if we don't do something about it, it's only going to get worse."