Healthcare

Dear Legislators,

Few services are more important than medical services yet due to efforts by the politically-active doctors’ lobby to limit supply, Californians have not always been able to get immediate access to such services. Your passage of AB 890 (Wood) in 2020 was a big step towards improving that environment but more must be done. A good review is provided by this excellent article in The Atlantic, which details the “costly, lengthy credentialing system” unique to the United States. With reforms, we can have not only more doctors but also more medical practitioners in aggregate.

We looked high and low for an article that exposed the poison pill buried in Section 100610 of AB 1400, a single-payer measure recently proposed and withdrawn in the California State Assembly, but found none. That’s worrisome. Typical single-payer systems are not governed by boards dominated by providers as called for by Section 100610, which would put the fox in charge of the henhouse. California already has a fox/henhouse problem on its public pension fund boards, which since Proposition 162 passed in 1992 must give precedence to beneficiaries, thereby delegating residents and taxpayers to subordinate roles. That’s how, eg, CalPERS’s board employed biased actuarial assumptions in 1999 to justify a retroactive pension increase the cost of which is still crushing services and taxpayers today.

It’s that time of year when California state legislators rush to introduce bills before a February deadline. Because it’s also an election year, many — including some to whom we give support from time to time — support bad bills that are good for them politically. We will work to defeat those bills but not to defeat those legislators unless alternative candidates from their districts are better bets for us.

Whenever I use Medicare, the government pays a health provider of my choice even if the provider is not operated by the government. The same goes for Medicaid, which uses public funds to pay for the care of 15 million Californians.

San Francisco Unified School District spends up to 250% more than the average CA school district on OPEB, which are insurance subsidies for retired employees.

November 1 marked the commencement of the Open Enrollment period during which residents can purchase health insurance for the upcoming year and another opportunity to praise Covered California, the state’s healthcare exchange that’s an exemplar of government services well provided. At a time when even the New York Times is cynical about blue state performance, Covered CA is a reminder that California’s government can do its job well.

If ever you needed a reminder that our nation has always been a confederation of diverse states united only when facing a common enemy, re-read Democracy In America, Alexis de Tocqueville’s 1835 masterpiece.

This year California will devote more than $120 billion to Medi-Cal, the state’s version of Medicaid that serves more than one of every three residents.

Dear Legislators,

We are pleased that 94% of Californians now have health coverage. We’d love to see that figure rise to 100%. Multi-payer universal coverage systems such as those that dominate continental Europe and towards which California is marching can work extremely well. But one big difference is that European systems do a better job of controlling costs and utilization. That’s one reason the US devotes so much more of its GDP to health spending without getting much better health in exchange, and also why some enterprises — including providers doing business with the state who make political donations — are so profitable.