Tuesday, July 17, 2007

California Universal Health Care Act SB840 Kuehl

Now THAT’S what I’m talkin’ about, a single-payer all-services-provided health care system that doesn’t increase costs. It’s a thing of beauty, all 87 pages of it.

To trim it down to the basics, this is what it does:
  1. Create a commission to figure out how to do it that starts working on January 1, 2008.
  2. Gives them 2 years to get it up and running.
  3. Eliminates insurers and replaces them with a single entity.

These are some of the stated assumptions upon which the bill is founded:
  1. Health care spending continues to grow much faster than the economy, and efforts to control health care costs and the growth of health care spending have been unsuccessful.
  2. On average, the United States spends more than twice as much as all other industrial nations on health care, both per person and as a percentage of its gross domestic product.
  3. Consumers can no longer rely on traditional health care coverage due to a continuous decline of employer-offered coverage, unstable employment trends, uncontrolled increases in the amount of premiums and cost sharing, and increases in benefit gaps.
  4. One-half of all bankruptcies in the United States now relate to medical costs, though three-fourths of bankruptedfamilies had health care coverage at the time of sustaining the injury or illness.
  5. Health insurance companies have insufficient business motive to provide comprehensive and affordable health care coverage to residents who are likely to require health care services.
  6. The World Health Organization ranks the United States below all other industrial nations and 37th overall in population-based health outcomes.
  7. Emergency departments and trauma centers face growing financial losses, and uncompensated hospital care totaled over one billion dollars ($1,000,000,000) in 2000. The burden for providing uncompensated care falls disproportionately on a minority of hospitals in California and leads to significant financial instability for the overall health care system.
  8. Multiple quantitative analyses indicate that under a single payer health care coverage system, the amount currently spent for health care is more than adequate to finance comprehensive high quality health care coverage for every resident of the state while guaranteeing the right of every resident to choose his or her own physician.
  9. According to these reports and numerous other studies, by simplifying administration, achieving bulk purchase discounts on pharmaceuticals, reducing the use of emergency facilities for primary care, and carefully managing health care capital investment, California could divert billions of dollars toward providing direct health care and improve the quality of, and access to, that care.
  10. It is the intent of the Legislature to establish a system of universal health care coverage in this state that provides all residents with comprehensive health care benefits, guarantees a single standard of care for all residents, stabilizes the growth in health care spending, and improves the quality of health care for all residents.

Now the thing is, can they keep it clean? Looking at medical industry related contributions for the ’05-’06 year we see that pretty much every elected official in the state of California has accepted contributions directly from the insurers, and probably even more through the various PACs. Data isn’t in for the current year, but we can assume the attempt at graft is continuing. But I ask again, can they keep it clean?

I recall a scene from West Wing where Alan Alda, beautifully playing a somewhat slimy Republican running for president, is being rebuked by an aide for taking money from someone whom he knows he will not support down the line. The beautiful response from Alda, taking a pull of scotch, was, “Well if we can’t drink their booze and take their money without giving them anything, what good are we as politicians?”

Yeah, I know, its just TV. But we can hope we have some of those kind of politicians finally working for us in Sacramento.

Help pass this bill, please. Write your state Senators and Congressman. Write Arnold. Write the paper. Tell your neighbor, your co-worker, and other members of your congregation. Tell your kids to tell their friends. Get it passed.


Blogger Christian Democrat said...

I've been told that this legislation would take a 2/3 vote to pass and that, with the Republicans universally voting against it, there is no chance that this will pass. We need to replace those GOP folks with good, people serving Democrats!

8/03/2007 12:12 PM  
Anonymous Tim said...

The World Health Organization ranks the United States below all other industrial nations and 37th overall in population-based health outcomes.

I just looked at this ranking. It puts Denmark above the US. I have no idea how they arrived at that conclusion, but my own experiences say otherwise.

When I was younger, I was with my family in Copenhagen when my father had what appeared to be a heart attack. They called an ambulance and took him (we took a separate vehicle) to an emergency room.

They checked him out, nothing was wrong, and the service was absolutely free. Great, right?

Not so fast. The "ambulance" was basically a glorified station wagon. The "ER" consisted of an old cot, an empty room, bare wooden floors, and a few basic bits of equipment such as an old-looking heart monitor.

Dad had actually had a heart attack in the US, a while before, and I knew firsthand the huge difference in the kind of equipment and facilities that were available. In comparison, it was like being a third-world nation. We were all grateful nothing worse was wrong.

But that's not all.

We have a few relatives in Denmark: most the ones we know well are getting older. A while back, one of them contracted cancer. We asked if he'd be getting chemotherapy. Chemo? was the confused response. Oh no, they just let him pass away, with no intervention.

I don't know how the WHO builds its ranking, but, I'm sorry to say, my firsthand experiences say there's something amiss there.


Okay, that was easy. It turns out that the WHO's rankings seem to be based on life expectancy...

"Another broader measure used to compare health in countries is Healthy Life Expectancy. This is the basic indicator of population health used by the World Health Organization and published each year in The World Health Report. This indicator measures the equivalent number of years in full health that a newborn child can expect to live based on current death rates..."

And guess what? The way we calculate our life expectancy generates a significant difference with other countries, one skews our life expectancies downward. See here for example:

"The U.S. rate for the first day of life was 3.88 per 1,000 live births, which was 2 to 3 times higher than those of many of the other countries, and more than 1 1/2 times higher than that of the United Kingdom which had the next highest rate in this category."

In other words, in the US is actually following the WHO guidelines, and recording any live birth where there are "signs of life", whereas other nations are many times more likely to write that infant off.

In short, we try harder to save more newborns, and record more live births (where other countries don't) and thus we're penalized in the WHO rankings for it. So, unsurprisingly, he Journal of Epidemiology finds:

"Differences in birth registration practices for infants weighing <1500 g are primarity responsible for the poor, deteriorating performance by the US in the International rankings of neonatal mortality rates." [1]

There are other factors also involved in life-expectancy calculations, like crime rates, which make a it poor indicator for healthcare. If someone dies in gang violence, that indicates a troubling problem, but it isn't immediately clear that particular problem would have been solved by, say, better EKG machines.

LA has far more gangs, and resulting gang violence, than Copenhagen. I'm not sure poor healthcare is the reason.

The same could be said for deaths from car crashes, unhealthy eating, sedentary lifestyle (too much time in front of the TV), recreational drug use, extreme sports, etc. These all reduce overall life expectancy (again, the WHO's measure), but it isn't clear how the quality of medical care (the topic at hand) is a primary factor in these behaviors.

Another difference involves racial disparities in birthweight (yes, back to that again). For whatever reason, the CDC reports that infant mortality rates among black babies (14/1000 births) is 2.5 times higher than for white babies (5.7/1000). Again, we might guess that it's a disparity in healthcare, until we find that this number closely tracks the percentage of low birth-weight babies born to each race, suggesting that the problem is low birth weight.

And why the low birth weight?

It seems low birth weight correlates strongly with low maternal age, low socioeconomic levels, and, most strongly, with an unwed mother.

"In 1992, the rate of low birth weight babies among unmarried mothers in the United States was 10.4 percent, as against 5.7 percent among married mothers."

So if the US has a large poor group who is, for whatever reason, having babies at a young age out of wedlock, that's a serious problem. But it isn't immediately clear that it's a healthcare crisis, much less one that a single-payer system will magically eliminate.

(In fact, UK has socialized medicine, and yet, according to a recent study, "almost half the black children in Britain are being raised by single parents".)

My point isn't that any of these problems aren't serious, or shouldn't be tackled. Indeed, I believe we should try hard to solve them.

My point is just that the WHO statistics measure many things which are either tangentially, or not at all, related to healthcare.

(And, worse, it may distract people into thinking a "silver bullet" will magically make all these underlying problems behind low life expectancy in the US go away. It won't.)

Thus a country which lets it's old folks die of cancer can be ahead of one who doesn't in the WHO rankings. I should think that's unhelpful for trying to figure out what needs to be improved.

8/13/2007 11:36 AM  
Blogger Christian Democrat said...

Great response, Tim -

Thanks for the relevant info and shared personal experience.

I don't doubt that the WHO rankings are skewed, all research tends to be done for a purpose and who knows what Who's is! ;>)

But seriously, my point is that we are being taken advantage of as a nation to the benefit of the insurers. Ask any medical worker and they will tell you it is the insurers that make their jobs miserable. As customers we are paying something in the order of 100-200% more than other nations for, at best, equivalent care. This additional cost is nothing but profits for middlemen.

As an example, I recently spoke with a guy that sells health insurance for a living. He is motivated and runs a small shop that sell primarily to businesses in a single state. His average yearly income is $750,000.00. He pays his brokers, total, about that same amount. So here we have about $1.5 million of profit that shows up as expense on the actual insurers P&L's.

With apologies to my friend, we need to get rid of the middlemen. That is the basic desire of single payer healthcare - lose the middlemen and keep the same quality that is currently in place.

As the U.S., by some accounts spends about $2 TRILLION on healthcare per year, we should be able to save at least half of that by eliminating the profits for the insurers.

And what jobs will those people have? I don't know but don't really care. They have been greedy long enough.

And a second personal experience - another friend has a nephew that is a VP in one of the national healthcare insurers. I am told they are working on plans already assuming that at some point it will be a single payer system. What those plans are, I have no idea.

8/13/2007 12:24 PM  
Anonymous Tim said...

CD (if you don't mind the abbreviation) -- also, great response, and shared personal experience! Thank you!

As an example, I recently spoke with a guy that sells health insurance for a living. He is motivated and runs a small shop that sell primarily to businesses in a single state. His average yearly income is $750,000.00. He pays his brokers, total, about that same amount. So here we have about $1.5 million of profit that shows up as expense on the actual insurers P&L's. With apologies to my friend, we need to get rid of the middlemen.

Great story -- and it raises a host of questions, to which I honestly don't have all the answers. For one: is he pulling your leg? (We'll assume not, but it's one of those things I always reflexively wonder about.)

And if he isn't, why are businesses so stupid that they wouldn't try to find someone who takes a slightly smaller cut -- say, just $500,000 -- and passes along the savings to them? And why wouldn't someone want to start doing that, and make, say, $500,000? What, if anything, is keeping that from happening?

I'd also like to know what kind of volume of business he does. Typical businesses actually take about 4% of the gross in profit. A million or two dollars (I'm rounding up) in profit sounds like a lot for one person, but if you're selling, say, $50 million dollars in product (or more) it's not really all that excessive. Local sales taxes (at 5-9%) take a far bigger bite.

But I completely understand where you're coming from: we look at a CEO who makes, say, $20 million a year, and think: Gee, that product could just be $20 million a year cheaper if we'd all take over the company and fire him. But somehow, it never quite works out that way -- not in healthcare, not in any other industry.

And think: if that worked for healthcare, why not do it for auto manufacture? Or computers? Or book publishing? Or everything else? There's nothing special or magical about the healthcare industry. If we could cut out the middle man and save money on insurance, medicine, etc -- then shouldn't we be saving money, in the exact same way, in every other business?

Believe me, it's been tried.


So why doesn't cutting out the middle man really work out?

Because monopolies aren't very efficient. It's one of the reasons I really dislike Microsoft. When you're the only player in the field, the natural human temptation becomes to do as little as possible to collect as much as possible.

This is true for any organization, and government agencies aren't immune, since they're staffed by sinful human beings like you and I. Power corrupts, and none of us, this side of the resurrection, are immune. Governments just have slightly less obvious ways of failing and exploiting us.

Think HealthSouth is wasteful and fraudlent? (It is, by the way.) But, frankly, it's nothing compared to the gross negligence of Medicare/Medicaid. Have you looked into how much of that waste is squandered? Your friend's profits are most likely nothing in comparison.

And unlike your friend, where we know his profits (just look at his tax forms), it's almost impossible to ferret out an actual complete picture of Medicare waste, because it's so deviously hidden. But there are some minimums we can easily detect...

"Nearly 8 percent of the bills Medicare pays for durable medical equipment aren't justified, a government report recently found, meaning $510 million spent last year on wheelchairs, walkers, braces and other items wasn't necessary. A 12-city survey found that one in 14 medical-supply houses participating in the Medicare program and one in nine applying to participate didn't even have an address..."

There's much more in the rest, and probably layer upon layer of skimming and waste even in the legitimate organizations and purchases. Yet any one of those waste areas, considered alone is probably a larger cut than your friend is making.

I'm serious: think about that.

And do we think that will ago away if we cut out the profit-making business part of that? Think again! The Soviet Union failed, in part, because even government employees found ways to siphon value of the system and into their own pockets. There was a huge black market in stolen, well, everything, and it was all stolen by people tasked with "serving the people."

Mankind is fallen and evil, my friend, and the only thing that works against that in secular mankind is when people can make choices. Then our greed pushes us to provide a better value than the next guy. The only thing that keeps us honest is that our waste must always show up in the final price tag, and the buyer can go to someone else who keeps his act together better.

But when there's only one option, you'd better pray it's good, because if it fails, you're utterly stuck. And it always fails in the long run, because that's one of the basic attributes of humankind. (If it weren't, we wouldn't need God, would we?)


Going back to businesses like HealthSouth for a moment: a lot of that fraud is encouraged (though I'm not excusing HS) by the government incentives which reward that kind of behavior.

Let me give you an example: My girlfriend works in a clinic helping stroke patients recover their abilities. She really cares about her patients, and is frustrated that her management doesn't seem to all that concerned about what's best for those patients. And there's also a constant incentive to push therapists to spend less and less time on each, and see more and more patients.

Why? Because the government is paying most the bills. They can do pretty much anything, with any outcome, and the cash still rolls in. Because the patients and their families don't get a say in the choice of facility, and the people paying the bills (the faceless drones at Medicare and Medicaid) don't care that much, because they're doling out someone else's money. They have other things on their mind, like not rocking the boat, embarrassing the head of their office, or making waves.

(No offense to them, and there are some wonderful counter-examples, but in my experience, government employees are often some of the least brave people I've encountered. If you have questions about this, have a sister (or other relative), as I do, who works for a government agency, and have her tell you stories.)


So what would I do instead? After all, I'm not being constructive if I don't suggest some alternatives.

(1) Always co-pay. No matter what. Nothing is as expensive as when it's free. If a person has to put some investment (even on a sliding scale) into what they're doing or receiving, they will care about the outcome. I don't care if the person is a quad in a wheelchair and is dead broke: perhaps they could just take 30 minutes a week and encourage other paraplegics or quads as their "payment."

My bible tells me that God has given everyone gifts, so therefore everyone can be of some small benefit.

And why require this? This is a basic biblical rule of welfare, which the Apostle Paul laid down from the start, in the world's first "communist" society:

"... even when we were with you, we gave you this rule: 'If a man will not work, he shall not eat.'" (2 Thes 3:10)

Note: not cannot work, but simply will not. If they truly can't, well, then fine -- out chance to show people what true love actually is. But if there's any small thing which can be done, then they should contribute.

I'm convinced that's not simply said for practical reasons, but because "idleness" is bad for us, where as we're ennobled and humanized when we feel like we're involved and contributing.

(2) Conversely, and from the same source, no help for anyone who can take care of themselves. No Bush free medicine plans for rich old ladies, etc. My mom gets that, and she loves it. But why should she? We're not poor, and if she couldn't afford it (and she can), I would. The money should be going to someone who can't afford it and doesn't have a caring family.

(3) More competition and choices for people, not less.

This is a bit trickier, since recipients can be corrupt too, but if people had more say in where their treatment dollar was going, it would encourage more competition (and a better value delivered) for the patronage of patients and their families.

(4) Perhaps we could have several different competing welfare agencies in the government, and people could choose which one their mandatory minimum tax dollars went to, in whatever percentage they wanted. And patients (provided they were conscious) could choose which to work with.

Then the agencies would be bending over backwards (perhaps, if the incentives were right) to show us that each was doing the best job for people.

And what incentive would make them bend over backwards to help us? What motivates people, CD? A selfless love? Sometimes, but not always. People get motivated by (and I know you're going to hate this, but it's true) ... compensation. So yes, we'd have to compensate those who ran their agencies better for the value they saved and delivered.

But you know, by the time we've gotten to step #4, we're almost back to private charity, only with a required minimum contribution by each.

Sweden, that famous socialist state, is backing off the "single-payer" idea at the same many in the US are starting to fall in love with it. (Can't we learn from their experience?) I'm no expert, but it sounds like they're adopting something a bit similar, at least in some ways, to what I'm suggesting above. And I've heard positive reports, and want to look into it -- but it doesn't seem to be a classic single-payer system, Canada-style.

So, two parting questions, at risk of being hideously boring:

(1) If Medicare and Medicaid waste more money than the average non-government-related business takes in profit, why on earth should we expand the power of that kind of agency? Why on earth do we think we're going to get a completely different result?

If we can't yet run Medicare without tons of waste, why should we plunge headlong into moving even more medical care under the same kind of incentive structure?

And, (2) if it "eliminating the middle man" saves us money on healthcare, why shouldn't we have the government take over every business? Isn't it worth saving all the rest of that money too?

Most sincerely...
- Tim

8/14/2007 1:36 AM  
Blogger Christian Democrat said...

Tim -

With all due respect I'll say that my reflexes are jumping pretty strongly at the moment. Your words lead me to believe you may be a lobbyist for the healthcare industry or some such.


To answer just a few of your myriad of questions:

1. Yes, he really does make that much money from two small offices in a single state. I don't know what his gross is.

2. Chy cut out the middleman in healthcare and not some of the other industries you mentioned? Very simply there is real competition in those marketplaces. In healthcare we have collusion. Free markets are a wonderful thing when competition isn't stifled by a small group of players getting together and rigging the system.

3. I'll actually go along with your concept of requiring a co-pay. It will keep some away. I'd also want a way for those that can't pay to be able to bypass the co-pay.

The rest, my friend, I'll leave alone but I will ask that somehow you temper your writing into a more concise form. What is it, are they paying you by the word?

With all due respect.

8/14/2007 6:49 PM  
Blogger Christian Democrat said...

I just read a wonderful account of socialized medicine by Jim Wallis, author of "God's Politics." If you aren't familiar with Jim or his organization, Sojourners (www.sojo.net), I highly recommend you stop by there.

Here is a link to Jim's recent article about a trip to "A&E" in London:


8/16/2007 1:25 PM  
Anonymous Tim said...

With all due respect I'll say that my reflexes are jumping pretty strongly at the moment. Your words lead me to believe you may be a lobbyist for the healthcare industry or some such.

If I was a lobbyist, I wouldn't devote that much time to having a conversation with one blogger, on a blog which apparently has a low readership compared to many others. (Not that there's anything wrong with that.)

Very simply there is real competition in those marketplaces. In healthcare we have collusion.

It seems it's not that hard to start an insurance company. I don't see any evidence of "collusion" among insurers -- instead, it looks as if medical costs actually are high, and high insurance rates simply reflect that.

Do you have concrete evidence to the contrary?

Free markets are a wonderful thing when competition isn't stifled by a small group of players...

The only time you get a "small group of players" is when barriers to entry are high.

Example: there are only a few Phrama companies because they've worked with the FDA to make it hard for new players to enter the field. We tend to think they *hate* regulation, but they love it in cases where it makes it impossible for new competitors, who have less money, to develop competing drugs or treatments.

The solution, in those cases, is to lower those barriers to entry, not produce a much larger monopoly consisting of an even smaller group of players.

In contrast, there are easily dozens of health insurance providers in the US. If so, that doesn't seem to match the example you've chosen.

The rest, my friend, I'll leave alone but I will ask that somehow you temper your writing into a more concise form. What is it, are they paying you by the word?

Apologies! ;-) As they say: sorry that was so long -- I didn't have time to make it shorter.

Thanks for your answers, above. But, again, seriously: why do you think government waste will suddenly amount to *less* than the profits your friend is making, when it apparently doesn't now?

8/18/2007 4:10 PM  
Blogger Christian Democrat said...

I find it interesting that in answering my question as to whether he was paid to write these responses he "answered" without answering. How very Republican of tim.

I've decide to cut tim off. Any further posts from him will be deleted.

8/18/2007 9:56 PM  
Blogger Christian Democrat said...

One more thought on this - I wrote that it was "very Republican" of tim to avoid answering the question. In truth, Democratic Party politicians are as likely to maneuver in this manner when they don't want to answer the question.

That is one of the great faults of our politicians. We need straight and honest answers from our elected officials. If they don't give them, don't vote for them.

8/19/2007 9:11 AM  
Blogger cujo88 said...

I respect your honesty that both parties avoid answering questions, but personally, I think the reason why health care is so terrible is because the government can't carry the world on its back.
I think privatizing health care would be the best solution because it would reflect the prosperity that our private capitalist economy has enjoyed throughout the 20th century.
Think about it for a second. Where there's competition, companies have an incentive to make their product better. Otherwise they go out of business.
So if we have exuberant competition for health care, the health care companies will all strive to make their product better and less expensive than their opponents.

10/30/2007 2:52 PM  
Anonymous Anonymous said...

I have relatives who live in Great Britain who have experience with their health care system.

A cousin of mine was very sick, and they waited until her health was extremely bad to do the necessary surgery.

Another cousin of mine brought her mother home from the hospital to provider her better care then available in the hospital.

If she was here in the U.S. they would have treated her right of way. I keep hearing how great these socialist programs are. But we never look at how they don't provide quality health care.

I think if you want a single payer system, then we can take all the money from the super rich in this country who support all these socialistic programs. Then they would have to use the same hospitals as the poor people that they claim to care about

Right now they can go anywhere to get quality healthcare.

11/04/2008 3:50 PM  

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