Despite opportune timing of a major piece of legislation, efforts by advocacy groups and a system generally considered in critical condition, health care has failed to materialize as a major issue in California’s gubernatorial race this fall.
“I guess there’s still a chance if we have some kind of health care ‘event’ or ‘development’ before election day, but that’s not very likely,” said Anthony Wright, director of Health Access, a statewide consumer group.
The single largest “event” or “development” has come and gone with little fanfare. A landmark universal health care bill four years in the making, SB 840 by Sheila Kuehl (D-Los Angeles), was passed by the Legislature in August and vetoed by Gov. Arnold Schwarzenegger (R) in September. Both events were mentioned in newspapers and television broadcasts, but they were short mentions appearing at the bottom of inside pages or just before the commercial break halfway through the evening news.
Phil Angelides, Democratic candidate for governor, sidestepped the issue, declining to say whether he would have signed the bill if he were governor.
Judging from candidates’ reactions, media coverage and at least one voter survey, downplaying health issues appears to be politically safe in this election. In August, the Public Policy Institute of California asked voters “Which one issue would you most like to hear the gubernatorial candidates talk about before the Nov. 7 election?”
Immigration was the top response, mentioned by 21% of the likely voters surveyed. Public education was next with 18%, followed by jobs and the economy at 9%, the state budget deficit and taxes at 8%, and the environment at 6%.
Health care came in a distant 6th in this popularity race with only 4% percent of voters contacted by PPIC citing health insurance coverage — so few the issue wasn’t mentioned in the survey summary.
Health care’s low profile on the rest of the November 2006 ballot might have had something to do with its failure to become a key issue in the governor’s race.
Mark Baldassare, research director at the Public Policy Institute who conducts the California Statewide Survey, said health issues’ low priority was unexpected but explainable.
“I was a little surprised,” Baldassare said, “but this has not been a statewide election or a ballot that is dominated by health care issues, for instance, compared to the 2004 election.”
Baldassare says part of the discrepancy between general public perceptions about health issues and what happens in elections stems from what he calls California’s “exclusive” electorate.
“Most of the California voters are older and affluent, and have some kind of health coverage from their employers, retirement plans or government, according to our past surveys,” Baldassare said.
They probably aren’t representative of the state’s general population, which includes millions of uninsured and underinsured people, but people with health insurance are the ones who vote, Baldassare maintained. And therefore they make the decisions about who gets elected and what ballot measures pass and fail.
So even if health care might be of more importance to the general population, it isn’t that important, evidently, to likely voters. And consequently, it’s not as crucial an issue for the two men running for governor — although both would argue vehemently that it is.
“Health care is a weird issue in politics,” Wright said. “At one level, it’s a very basic, fundamental issue that always enters into the discussion along with education and the economy. But it’s unlike other issues at another level because very few people identify themselves as patients, even though we all are, from time to time. Everybody knows it’s important and needs to be dealt with — especially seniors — but in the world of identity politics in which people think of themselves as students or teachers, people of color, people of faith or some other group, health care is different. People don’t want to think of themselves as patients,” Wright said.
While it has not been a focal point of the race, both candidates have attempted to get political mileage with health care.
Schwarzenegger signed several health care-related bills in September, most notably legislation to create a prescription drug discount program and extend and expand children’s health insurance coverage. And late last month, he hired advisers from opposite ends of the political spectrum to help draft his long-awaited plan for harnessing rising health care costs and dealing with the state’s six million uninsured residents. The governor said the plan will be ready for public scrutiny next year, if he’s re-elected.
“One could make the case that the governor has not focused on health care for three years and now he’s trying to make up for it in the past three weeks,” Wright said.
Angelides, with as much fanfare as his campaign could muster, last month released his plan for reducing health care costs. He proposes legislation to prevent health insurers from spending more than 10% of their revenue from premiums on administration and overhead. Angelides said his plan would cut $4 billion in costs from the health care system and would result in lower premiums for consumers.
Health care issues might not be foremost in voters’ minds this fall, but the governor’s race has not been forgotten by the industry. So far, the health care industry has injected $4 million into Schwarzenegger’s re-election campaign, according to the Foundation for Taxpayer and Consumer Rights. By comparison, the Angelides campaign has received $120,600.
Much of that money comes from insurance companies worried by loud footsteps of change around the corner. They’ve been hearing them for a long time now, but the sound may be getting louder.
Recent research indicates a majority of citizens — nationally and in California — approve of the idea of universal or single-payer health care, a system that could eliminate or drastically reduce the need for private health insurers. These citizens aren’t necessarily voters, however, and that may be why change is so slow in arriving.
Judging from the sprinkling of recent state and local attempts to solve the dilemma (most notably in Massachusetts and San Francisco) and the wide margin of victory Kuehl’s SB 840 had in the Legislature this summer, it may be that our culture — and California in particular — is moving toward embracing some kind of universal plan.
“Majorities of Californians in the PPIC Statewide Surveys have consistently said they approve of the idea of universal health coverage, so we are there in terms of public support,” Baldassare said. “The challenge is bipartisan support in the legislative or initiative arena.”