Commentary

Letís Make A Deal On Health-Care Reform


By Mark Baldassare, president and CEO, Public Policy Institute of California
This opinion article appeared in the San Francisco Chronicle on July 5, 2007

With the end seemingly in sight for the annual haggling over the state budget, Gov. Arnold Schwarzenegger and the Legislature are looking for a sequel to top last summer's global-warming bill. In doing so, their focus will soon turn to the elusive goal of a bipartisan compromise on universal health care. This year, state lawmakers can count on the public to cheer them on and their political ambitions may lead them to find a way to expand coverage for the millions of uninsured Californians.

Before moviegoers had a chance to view "Sicko" - the latest installment in Michael Moore's dark commentaries about what's wrong with America - Californians were expressing deep reservations about the way we go about providing health care. In our Public Policy Institute of California statewide survey of 2,003 adults conducted from June 12 to June 19, 3 in 4 Californians said that major reforms are needed in the state's health-care system. Democrats and Republicans, men and women, young and old, and insured and uninsured alike are all convinced that big changes must be made.

What health-care issues are most distressing? Again, 3 in 4 believe that the number of uninsured people is a big problem today. Residents of all political stripes, racial and ethnic groups and regions of the state find it very troubling to have a health-care system that leaves so many people without health insurance. Their level of concern may seem surprising, because 8 in 10 residents report having some form of health coverage and 9 in 10 of them say that they are satisfied with their health-insurance plan, until we factor in their deep feelings of insecurity.

Our June survey showed that 2 in 3 residents worry about having to pay more for their health care or health-insurance policies. Moreover, 7 in 10 adults express concern over how they would afford necessary health care if a family member gets sick. Some say they know family members who have been without health coverage recently, while others worry about losing their own insurance. While these anxieties are high for lower-income residents, affluent groups are not immune from such fears.

In January, the governor proposed a health-care plan that would require all Californians to have health insurance with costs shared by employers, health-care providers and individuals. Today, 7 in 10 likely voters favor this proposal - nearly identical to the level of support when this idea was unveiled - with majority support across political and demographic groups. The Legislature has proposed its own health plan, which is also likely to generate favorable responses from a concerned public.

Solid majorities of Californians, mirroring the national surveys by the Kaiser Family Foundation and others, say the United States should provide a national health-insurance program, even if it would require higher taxes. Most Californians also favor a guarantee of medical coverage for low-income children and would agree with requiring employers to offer insurance or pay a fee to cover health-care costs. But residents have given up hope that President Bush and Congress will reach a bipartisan agreement on a national health-care plan, given the track record on the Iraq war and immigration this year.

However, Californians are reasonably optimistic that their Republican governor and Democratic-controlled Legislature can work together on health care, based on last year's legislative successes on environmental policy, minimum wage, prescription drugs and infrastructure bonds. Schwarzenegger is now the champion of universal health coverage, and Democratic leaders are steadfastly committed to the idea. State lawmakers can look to other states, and to San Francisco, for examples of policies that expand health coverage - policies that essentially fill the vacuum at the federal level.

While the governor and the Legislature are still far apart on the health plan's details - such as who pays and how much - political imperatives improve the chances of an agreement at this time. A successful plan would focus the national spotlight on Schwarzenegger during the 2008 GOP presidential primary and would give voters a reason to support the legislative leaders' proposal for term-limits reform that would keep them in power. If these health proposals falter, worried voters may turn to ballot initiatives to fix what they see as a broken health-care system.

Publications

PPIC Statewide Survey: Californians and Their Government, June 2007

PPIC Statewide Survey: Californians and Their Government, January 2007

Health Insurance, Health Care Use, and Health Status in Los Angeles County