The Daily Planet sat down with the four candidates in the California Assembly District 14 race recently and asked their views on various issues. The Daily Planet will reproduce portions of their responses in upcoming issues, beginning this week with the issue of health care.
Last year, two different pieces of legislation were introduced in Sacramento to change California’s health insurance system. One was a packet of legislation by Senator Sheila Kuehl of Santa Moncia, SB840/SB1014, the so-called single-payer packet, in which California would have set up a system of universal health care, similar to what is present in Canada and the United Kingdom.
The second was the coalition package (AB8/ABX) that originally began with an alliance between Senate President Don Perata and Assembly Speaker Fabian Nuñez, eventually including Gov. Arnold Schwarzenegger, but Perata ultimately withdrew his support from it after the projected budget deficits were announced.
The AD14 candidates were asked how they would have voted on both of these legislative packages, as well as what their own health care legislative goals would be if they won the Democratic nomination in June and were elected to the legislature next November.
Phil Polakoff, Berkeley physician
I want to quote what I heard last night, listening to Barack Obama, “the urgency of now.” What I want to do in California is the “urgency of now,” what is needed now, and what is needed to do a structural overhaul of the entire health care delivery system. It’s not just saying we need single payer, we need to reform health care completely. We need to have the conversation. And we have to have all the stakeholders at the table. We can’t just have a bill that’s run by the California Nurses Association and blocked by everybody else. Everyone’s going to have to be at the table. And it’s going to have to be both parties. It can’t be just Republicans or Democrats.
If I can accomplish four things, I’d be very satisfied that I made a contribution to the state.
If I can, one, raise the level of involvement of all parties in disease prevention, health promotion, that’ll be a plus. To take on the issue of the rampant nutritional issues that are leading to the increase in obesity and diabetes. To take on the problems of air quality resulting in instances of very elevated rates of asthma. Two, if I could make sure that we legislate that no person is denied health care because of pre-existing condition. That’s doable. Three, if I could deal with the fact that people are having their health insurance taken away after they have catastrophic illness. That would be a success. Four, if I could make the state better prepared for any sort of emergency, so if there’s an earthquake, or if there’s a pandemic flu, that we’re better prepared.
We’re not going to solve all these problems, but if we can make the people of California healthier, better prepared from a major assault, whether it’s deliberate or non-deliberate. The emergency rooms are ill-prepared to take on a major problem. Those are the four major things.
There’s no lack of energy put into the reform effort last year. It just wasn’t done correctly. You can have a lot of action, but last year I don’t think the action was in a way that would get specific goals accomplished. All we have now is an incredibly complex, convoluted, inefficient, frightfully expensive delivery mechanism. If you have the access, and you know where to go, you can get the best treatment in the world. But if you don’t know where to go, you don’t have the access, you don’t have the knowledge, it’s frankly scary to people involved in the process, at any age. I would like to be the point person in reigniting the dialogue, and the conversation.
When I was in the legislature [in the 1980s Polakoff worked as a consultant to the state senate's industrial relations committee on workers’ compensation issues] there was always good politics and good policy that everyone could end up being proud of. AB32, the global warming solution, that’s something I think people are proud about. AB12, childhood nutrition, I think that’s something people are proud about. I don’t think anyone really is proud about AB8, ABX, or these other similar bills as they went through the process. I think people worked very hard. I think there was some positive movement. So if you ask me if I’d be happier if we had accomplished something, yes. It would have been incremental, but we would have made some forward movement. And it could have been amended, and we could have learned from it. Now there’s a demoralization. The forces up there don’t know where the leadership’s coming from. There’s those that believe we can redo SB840, single payer. History hasn’t played well on that. And we don’t have the resources, right now, to do a complete re-do of the entire health system. So we need to work on more incremental steps, with pilot projects.
Nancy Skinner, East Bay Regional Park Director
The current state of health care is that the haves have it, and more than the have-nots do not. And when I say more than the have-nots, I mean that there are many people working 40 hour per week jobs, skilled people, trained people, doing high-quality 40 hour per week jobs, who have no health care. Because their job doesn’t provide it, or they are self-employed and the insurance companies won’t give it to them, either because of pre-existing conditions or because of some other problem. So basically you have this incredible crisis in health care in California. You have up to 7 million without any health care. And then you have a whole separate category of people with, really, inadequate because either their deductible is too high, because it doesn’t cover lots of basic medical needs, or it doesn’t cover dental, for example. So health care is in a complete crisis, and we’ve got to fix it. It’s embarrassing. I don’t even want to use that phrase. It’s immoral, to be the seventh largest economy in the world and to not provide basic human rights.
Single payer is the most efficient method to provide health care for everyone. We should treat it like other basic services. Like fire protection. Like safety and police protection. We pool our resources, we put the funds together, and we provide the service. We should do the same with health care. And that’s basically what single payer is. And we have single payer now in the form of MediCal and MediCare. They still use private doctors and hospitals, so it’s not that you have to have the government run the delivery system. What single payer is, is a mechanism for paying the resources and having employers contribute, employees contribute, state income tax contribute, to provide health care for everyone in the state.
As far as the Perata-Nuñez-Schwarzenegger effort, after it was written, my concern about that bill was that it didn’t go far enough in the process to get the kind of amendments that would have made it acceptable. It could have had the impact of creating a circumstance where employers who now provide health care benefits might drop theirs, because the mechanism that was being put in that bill might have made it cheaper but might not have covered adequately. So then people who otherwise had a pretty decent health care package with their employer might have lost that coverage. My understanding of the bill was that it would have still had some level of coverage, but it might not have been adequate. So there were a lot of aspects of that bill that really, before I could have supported it, would have needed a lot of amendments. And that discussion didn’t really take place, because it got basically pulled. So single payer, basically, is the way to go. It pools resources and provides for everybody.
Clearly, more organizing and development of more support needs to occur to get the political will to enact what is the most cost-effective system. In the meantime, there are other programs that we can expand. In the Healthy Families program, we can raise that so people of a higher income level can qualify. And we can create some mandates on employers to provide health care coverage. It’s still a worthwhile step, if we take some of our largest employers, like WalMart. The fact that they do not provide health benefits is a huge cost to the state. The state is, in effect, then subsidizing WalMart for the fact that they do not provide health benefits for their employees. So mandates like that. And negotiating with the pharmaceutical companies to put caps on the price of those medicines. California could do that.
Tony Thurmond, Richmond City Councilmember
As you know, 7 million Californians are without health insurance. And that is just wrong in a state that has the wealth and resources that we do. We can fix health care. I support single payer. I passed a resolution in our City Council supporting SB840. I work on health care on some basis with youth in Alameda County who are transitioning out of foster care. We provide a clinic for them and we provide some referrals to mental health services. Many of the youth have MediCal, which is awfully underfunded. So the governor wanting to cut the budget in critical areas like MediCal, for a clinic like mine, what we get back for our reimbursement rate is something really low. Probably 30 percent of the actual cost that we put out. We raise grants and contracts. We have contracts with the Alameda County Social Services Agency.
So the governor’s cut threats to social services has a threat not just to MediCal but to the youth population that we serve, who don’t have insurance. Many of them are over 21. After 21, they are no longer eligible for even MediCal. So I think we need a system like single payer. I’ll advocate for that in the legislature. I think we need a system that puts patients over costs. Every dollar that we spend on health care, a big chunk of that money, maybe a third, is going to overhead and administrative costs. I’m going to advocate for a single payer system, and if we need to work towards incremental systems while we’re getting there, getting to a larger system, I will always place emphasis on reducing costs, so that we’re focusing on those who need care.
As far as the Perata-Nuñez bill, I want to preface my remarks that I would have pushed for single payer. That’s from a policy perspective and a personal perspective. My brother, who was 35, passed away in 2004. He lost his job. He lost his insurance. He stopped taking care of himself. He later was diagnosed with a liver disorder that he never knew he had. A very rare liver disorder. I believe that if he had insurance, he would have taken care of himself, and he might still be here today. There’s no guarantee. But I know from experience that people make choices sometimes and not take care of themselves when they’re not sure how to pay for it.
I read a study about cancer. It’s on the rise in the African-American community, where people aren’t going to a doctor because they weren’t sure how they were going to pay for it. That’s why I have the preference for single payer, because I think that when people start making sacrifices that are going to impact their health, we’ve got it all twisted. Having said that, if it’s going to take hard work and long term advocacy to get to single payer, and we need to do this incrementally, I could have supported the Perata-Nuñez bill if it placed emphasis on containing costs. I’ve been an employer and a supervisor for 15 years. And I’ve seen that it is important that employers provide health care for their employees. And I think there should be a greater emphasis on asking the employers to provide health insurance to their employees.
Kriss Worthington, Berkeley City Councilmember
In a country and a state which is supposedly one of the richest and wealthiest countries and states in the world, we have incredible millions of people uninsured. And even ones who are insured are not adequately covered to take care of any kind of serious emergency. So I think many people would say that the health care system is in a state of crisis.
In the long-term, I support a single payer system to totally change the whole structure on the state and national level, for that matter. I guess one of the differences between me and what some of the other candidates say is I am realistic, and even though many moderate Democrats voted for SB840, that doesn’t actually mean that they support single payer and will fight to make it happen. At some of the candidate meetings, some of the candidates talk about SB840 like, oh, we’ve got that, we just need to get a new governor.
Sheila Kuehl is brilliant, having talked the Democrats into voting for it, and making Arnold Schwarzenegger the bad guy to veto it, but in reality, a lot of the Democrats didn’t actually support the companion bill [SB1014] which would have actually made it possible for SB840 to be implemented.
The difference between the two bills (SB840 and SB1014) is sort of like the difference between a proclamation from the City Council saying, “Wow, wow, wow, we think you’re great,” versus an ordinance or legislation actually funding something. So SB840, saying “we like single payer”, got approved. SB1014, the bill that would have actually made it happen, didn’t go anywhere. And there are a lot of Democrats who were against it, which isn’t surprising, given how much money the health care corporations and insurance companies pumped into state assembly and senate campaigns. It’s not shocking. The amazing thing is that [Kuehl’s] such a brilliant organizer that she was able to talk them into voting for the part that she did. But you can’t go to Sacramento in January thinking, well, we’ve got the Democrats on board, we’ve just got to get a new governor and we’ve got to push through single payer, and the public supports us.
The polls actually show that the public wants reform, but when the corporate interests spend their fortunes, as they did on SB2, the Burton one--- The polls show that the public supported that bill, which put more pressure on employers to provide more insurance. Once it got referended--the corporate interests spent enough money to put it on the ballot and referend it--it got voted down. And that wasn’t anything near as ambitious as single payer. So it’s awfully more complicated than some of the candidates let on.
As for the Perata-Nuñez bill, I would have aggressively tried to amend it. I think the state labor federation laid out some of the flaws remaining. In a way, I think my position would have been similar to theirs, in that I would have supported it if was amended. One of the flaws was that you were forcing some of these people to get insurance, but you were not making it so that they could afford the insurance. If you have a law that you have to have insurance and it takes up 50 percent of your income, what good is that law? There weren’t sufficient restrictions built into it. This has to do with the whole nature of how Democrats relate to Schwarzenegger. They cave in to him. But when Democrats have shown a backbone and stood up to Schwarzenegger, they’ve been able to defeat him.
When somebody wants to get something done, you push them to get something decent so that you can vote for it, but not have horrible, unintended consequences. If I were going to be the deciding vote on whether or not AB8 won, I could not have voted against it and made it lose, but I would have been fighting much more aggressively to try to get a series of amendments to it.