Nurses say no to Arnoldcare and Medifab

As Gov. Schwarzenegger and State Assembly Speaker Fabian Nunez insist their respective insurance-mandate health care plans are still alive, the California Nurses Association is actively fighting both plans in favor of a single-payer system similar to Canada’s. Michael Lighty, the association’s director of public policy, Donna Gerber, director of government relations, and Charles Idelson, director of communications, visited the editorial board recently to discuss their concerns. Some highlights:

Neither plan will control costs

Charles Idelson: Neither approach does anything to crack down on insurance denial of care, which is certainly one of the two most high-profile problems, or three most high-profile problems, in the current health care crisis. There’s nothing in either plan that addresses that. The second flaw we believe is that there’s nothing in either bill that does anything to control costs. Because if you look at, if you look at all of the major reports that have come out this year, and I don’t need to tell you guys about this; you know it very well, The New York Times had a huge editorial about it Sunday — that is the big issue that people are concerned about is one in six Americans who have insurance are afraid they won’t be able to meet their medical bills. Half of all personal bankruptcies are caused by unpaid medical bills. Yet under both of these approaches insurance companies can continue to raise premiums as much as they want, they can continue to charge as much as they want, they can continue to raise deductibles, co-pays on everything from — which is happening right now — you’ve got co-pays on everything from office visits to emergency room care to ambulance rides to prescription drugs to test. The average family knows this, you know, death by a thousand slices.

Eryn Brown: When you talk about controlling costs you’re talking about costs to the insured, or the individual, not costs to the system, or...

Donna Gerber: Or the employer, or...

Eryn Brown: Well, for the patients, not the cost of care, or. Because that New York Times editorial is actually talking about some broader issues, right?

Charles Idelson: Same issue. There’s no cost controls on cost of health care for employers. They’re still going to get socked with rising premiums.

Eryn Brown: But we’re talking about there’s nothing in terms of cost controls in terms of the amount of money spent on — because that New York Times thing I think is talking about some of the outcomes studies, and how much is spent on stuff that is arguably not the best treatment.

Michael Lighty: The only thing put out by the Nunez and Schwarzenegger plans is that because the uninsured cost providers money to care for them, the insured bear the burden of those costs. Therefore if we insure everyone we’ll save money. That’s the only argument they put forward. Secondarily, they say if we’re able to go to electronic medical records, there may be some cost savings there as well. The truth is though that the public doesn’t buy this argument, that we’re going to solve the cost crisis — as the Times editorial, the New York Times editorial said, um, you know that that’s not necessarily the major factor driving the costs — but also what you’ll see in some of the political reporting is that the voters are not buying the argument.

Eryn Brown: That...?

Michael Lighty: That if we cover the uninsured we’re we will save money. No-one buys that. With good reason. Because insurance premiums have gone up 87% since 2001. And certainly the cost of covering the uninsured has not gone up 87%. People know that the insurance companies, just as a, at a kind of gut level know that the insurance companies are gouging them for reasons having nothing to do with the actual costs of providing care.

Charles Idelson: And that 87% is just premiums. That doesn’t even count how much deductibles have gone up, co-pays have gone up, hospital charges have gone up, drug charges have gone up. Every aspect of the system. That’s how, you know, from our perspective that is the major, that is the major problem with health care costs, is what the health care industry is charging them and their incredible inflation, which no-one has proposed a solution for, either in California or nationally. Except for a system where you would have global budgeting such as single-payer system.

Where is the waste?

Donna Gerber: If we do this system in California, based on California statistics, based on he numbers in California, based on the demographics in California, what happens? As near as we can tell the truth is they can’t come up with the money, even to make even the theory that they have in the policy bill actually work financially. And we’re not surprised by that because the truth is if you take all the dollars that are being spent on health care by both the public and the private sector — and it’s roughly 50-50, you know the public programs including Medicare pay for about 50% and about 50% is from employees and employers and a few individuals — where the, where the biggest chunk of the money is is in the administrative costs, which are upwards of 30%. And by administrative what I mean is the amount of money it costs for insurance companies to process pieces of paper, billing claims, advertising, marketing, all the pieces of paper that you as you know, patients and your providers as providers and everybody else has to screw around with. That’s incredibly expensive, and studies that have been done, on, for example the (Sen. Sheila) Kuehl bill for a single-payer system. There’s about 30% waste in the system. And simply eliminating that bureaucracy is where the money is. It’s where the vast majority of the money is. Unless you want to cut benefits. If you want to cut benefits, and you want to do more, you know, make people jump through more hoops to get stuff, and you want to make people pay more, through co-pays, you know, all these other things, these mechanisms to make people pay more money, you can come up with more money. But if you want to have a comprehensive set of services that actually improve health care and actually improve health outcomes, the place to get the money is in the waste.

Tim Cavanaugh: Why would...

Donna Gerber: So their bill, even though they have it sort of theoretically constructed, no-one in Sacramento, no-one can actually demonstrate that it pencils out. And we don’t think it will.

Robert Greene: Would it cost people more, would rates go up as a...

Donna Gerber: They will raise rates. They will raise rates to try to make it work. The only way the balloon goes is increased rates, out-of-pocket co-pay, you know...

Vaporware

Michael Lighty: The reality is this plan is not designed to be enacted...

Tim Cavanaugh: The governor’s or the Nunez plan?

Michael Lighty: Both. In the sense that deferring the financing until 2008, and including taxes that will require at least a year to collect prior to their application, you’re looking at 2010 at the earliest for their program to be financed. The reality is that everyone knows politically that a Democrat in ’09 is going to do health care reform. And even if a Republican is elected health care is such an issue it will be dealt with in ’09 as well. Chances are, it’s almost certain that the federal government will do something in ’09 that will set national health care policy. It could be as modest as tax credits if it’s a Republican president. It could be as comprehensive as a plan similar to this or even single payer. And if we were serious about doing health care reform in California we wouldn’t be running up against a deadline, an artificial deadline to get something on the ballot in 2008. Because we would take another legislative year and do this thing right. The only reason to get this on the ballot, and your paper has covered it better than anyone, is because of the political needs of the speaker, primarily, and also of those supporting the term limit extension. They need this to buttress their claim that the legislature is meeting the needs of Californians. Look what we’ve done in health care reform. That’s the primary driver. There’s no other rational reason for this timeline.