California Urged To Make Changes, Reform or No Reform

Regardless of the fate of national health care reform, California should move ahead with efforts to improve a dysfunctional system, according to state and national health care leaders who came together for a one-day conference on Feb. 4 in Sacramento.

Originally organized to begin mapping out California’s strategies for dealing with national legislation that most observers predicted would be signed, sealed and delivered by now, the conference instead became a combination of a “What-just-happened?” look backward and a “We-can’t-stop-now” look to the future.

“The future is unclear at this point,” said state HHS secretary Kim Belshé, “but I want to stipulate that we do know a fair amount about the general direction we will move — with or without national reform. It’s important for us not to wait but to move forward in the areas we know need work.”

Alan Weil, executive director of the National Academy for State Health Policy, agreed, adding that because of California’s large, diverse population and an increasingly difficult climate for governance, the state “faces some of the same risks as they do in Washington.”

“We have a horribly inefficient health care system in this country,” said Weil, who estimates administrative and clinical inefficiencies account for as much as 30% or 40% waste throughout the system.  Discussions about how to deal with those inefficiencies often devolve into political “posturing,” Weil said.

“You’re a big state,” Weil told about 100 health care policymakers and stakeholders at the state Department of Health Care Services. “You run some of the same risks as they do in Washington — problems of posturing versus real discussion and questions of how local do you want to be with your delivery of health care,” Weil said. “There are fundamental questions — with or without national reform. It’s an issue of governance at whatever level you approach the issues.”

Shift in Focus

After more than a year of work on a national overhaul of the health care system, the election of a Republican senator in Massachusetts three weeks ago took the wind out of reformers’ sails and left politicians and policymakers in a state of limbo. Opponents hope the one-vote shift in the Senate will be enough to once more delay comprehensive national reform, an elusive goal in Washington since 1912, according to David Panush, adviser to state Senate President Pro Tempore Darrell Steinberg (D-Sacramento).

Tracing the effort for national reform back to Theodore Roosevelt and calling the establishment of Medicare and Medicaid in the 1960s an incremental steps toward a comprehensive national policy, Panush said, “Health reform is not a dead animal. But,” he added, “we have to move forward with what the state can do while we wait to see what Congress eventually comes up with.”

One of the key areas for California to pursue, Panush and others agreed, is renewing the state’s Medicaid waiver agreement, which garners extra federal money for hospitals and indigent care. California’s current waiver agreement expires Aug. 31. State officials hope to restructure the waiver agreement to provide better, more coordinated care for the state’s most vulnerable — and expensive — Medi-Cal population.

Panels Address Markets, Public Coverage

Two panels of experts, assembled with the assumption a national reform package would now be in place, addressed possibilities if a national reform package does not emerge.

Richard Figueroa, representing Gov. Arnold Schwarzenegger’s (R) office, Marian Mulkey from the California HealthCare Foundation, Micah Weinberg from New America Foundation and Lucien Wulsin from the Insure the Uninsured Project discussed market mechanisms in health insurance.

Lesley Cummings, executive director of the state’s Managed Risk Medical Insurance Board, David Maxwell-Jolly, director of DHCS, Richard Thomason from the Blue Shield of California Foundation and Daniel Zingale, representing The California Endowment, discussed methods for making the most of public coverage.

Moving Forward, Reform or No Reform

Consensus from those on stage, as well as in the audience, appeared to favor moving forward with California-specific programs, no matter what happens in Washington.

Belshé pointed out common goals in the reform effort that stalled in California two years ago and the legislation stalled now in Congress. She said California policy should aim to address these three themes:

• Increasing the number of people covered by insurance;
• Making health care coverage more affordable; and
• Increasing the emphasis on prevention of health problems.

“And there are clear ways to move forward with these things, including health exchanges, examining how to enforce an individual mandate. It’s important to keep focus on what we can do, not what might happen in Washington. We gotta get on with it. We’ve got work to do,” Belshé said.

Weil urged California leaders to look for ways to increase efficiencies in the health care system, in both the administrative and clinical arenas.

“There is an opportunity now to incorporate new federal tools to work on issues your state has already been pursuing … such as health exchanges,” Weil said.

He said legislators and policymakers should keep in mind that “your administration is in its last year, and it would probably be a good idea to start these processes in such a way that you leave something for the next administration to continue.”

Weil concluded the conferences with a new take on an old adage.

“We all know the optimist sees the glass half full and the pessimist sees it half empty,” Weil said. “The engineer says the glass is twice as big as it needs to be.”

“We can all be engineers in health care,” Weil said.

The conference, “Prospects for Health Care Coverage in 2010: Options and Priorities for California,” was organized by the Center for Health Improvement and California HealthCare Foundation. 

CHCF publishes California Healthline.