The Dec. 8 edition of The Weekly presents the conclusion of an interview with E. Richard Brown, the founder and director of the UCLA Center for Health Policy Research and a professor at the UCLA School of Public Health. His recent work focuses on health insurance coverage and the effect of public policy, managed care and other market conditions on health care access, especially with regard to underserved populations.
The first installment of the interview focused on Brown's analysis of the recent legislative efforts to expand health insurance coverage in California, the politics of extending health care coverage to undocumented immigrants and the implications of eliminating some coverage mandates for health plans.
In the conclusion of the interview, Brown discusses prospects for enacting health care reform legislation in California and how lifestyle programs can affect chronic disease care, among other issues.
Audio of the complete interview with Dr. Brown is available online.
Q: [Gov. Arnold Schwarzenegger (R)] appeared on NBC's Meet the Press recently, and he talked about his goals to extend coverage. The organization, Health Access, a health care advocacy group, estimates that it would cost about $6 billion to expand coverage to half of the state's uninsured residents. That figure seems really almost insurmountable. What's your take on that?
BROWN: I think it depends a lot on the way we go about doing it. I think if we start to require that employers and individuals in our state make contributions that are commensurate with their ability to pay, then I think we can spread the costs of expanding coverage to the people who would benefit from it, that is, employers not currently making a fair contribution, as well as individuals who could be paying at least something toward the costs of their coverage. We do need to understand that this is ... that the uninsured are predominantly a low-income population. Three-fourths have family incomes that are below 300% of the poverty level, which is equivalent to about $46[,000], $47,000 a year for a family of three. Those families, many of [whom] are struggling to get by, cannot be expected to bear the brunt of the costs of expanding coverage to them, so we do need to have substantial subsidies. But I think a lot of that can come from employers. Some of it can come from federal matching funds. But we do need to recognize that we're going to have to provide some tax revenues to help pay for it as well.
Q: One of the other items on the governor's list is efforts to promote a healthy lifestyle to prevent ailments. It sounds like a good idea. It takes a long time for the financial benefits of that to accrue back to the system, though, right?
BROWN: Well, it does over the very long run, but it's not that long a run because if we can really work effectively on improving people's health and their wellness, essentially, I think we can begin to realize some savings in a very few years. In addition, if we combine that with effective chronic disease management programs, then I think we can really see some savings, as well as improvements in the health of the population.
Q: So if you were going to put your hat on and take a look into the future, like a year from now -- after the legislative session is over, after the governor has announced his plans -- what do you think the health care landscape could look like in California a year from now? Do you think a year is going to be enough to make a change ... ?
BROWN: My guess is it's probably, even in the current climate of increasing intensity of interest and focus on this issue, that it's at least a two-year legislative process to get to the enactment of significant health care reform in California. But it's really going to take the strong political leadership of the governor, strong leadership from key legislators, and a lot of interest groups that have been standing on the sidelines watching this unfold and merely throwing rocks at the things that they dislike, stepping up and recognizing that they're going to have to be contributors to solving the problem and not just the bashers of proposals that they find distasteful to their interests for various reasons. And I think that especially includes the business community, which cannot just stand by and demand efforts to reduce their costs. [Businesses should] recognize that so many businesses in the state are not even making adequate contributions today to help pay for health care of their workers and their workers' families.
Q: Your center at UCLA -- will it be involved in this effort at all?
BROWN: One of the roles that our center plays is to provide analytic support to many of these different efforts. And we provide data and analysis to the governor and his staff, to the Legislature and to many advocacy groups, as well as to the media [for] use in [its] assessment of the magnitude of these problems and the characteristics of people who currently don't have coverage and who might be eligible under different scenarios for expanded programs ... as well as contributions. So we play a strong analytic role in supporting the development of these kinds of policy proposals.
Q: [Is there a]nything ... that you want to say about the upcoming, "Year of health care" that is supposed to be the governor's signature issue and maybe the big issue in California ... ?
BROWN: Well, I think this is an opportunity for California to really step out in front of many other states in the nation in showing real national leadership as a model of addressing these programs. One of the things the governor talked about on [Meet the Press] was the fact that he, as a Republican governor, was able to work very closely with a Democratic legislature in the last legislative session, and that has a potential to produce a really positive and progressive health care reform in this state. I hope that he and the Legislature find the political courage to follow through on that and come up with a proposal that really addresses the needs of Californians and doesn't take simply the easy task of aiming at ratcheting down coverage in order to be able to say that we have expanded health insurance coverage, when, in fact, we may not through that mechanism be expanding health security, which is really what we ought to be aiming at.
Q: ... [T]hank you so much for your time.
BROWN: My pleasure and thanks very much for the interview.