The state of health reform in California

Sheila Kuehl is an amazing an sensible voice in California politics:

She is a termed-out State Senator who now sits on the California Integrated Waste Management Board.

She was the first openly gay or lesbian person to be elected to the California Legislature.

She was the first woman in California history to be named Speaker pro Tempore of the State Assembly.

In her fourteen years in the State Legislature, Sen. Kuehl authored 171 bills that were signed into law, including legislation to establish paid family leave, establish the rights contained in Roe vs. Wade in California statute, overhaul California’s child support services system; establish nurse to patient ratios in every hospital; require that housing developments of more than 500 units have identified sources of water; further protect domestic violence victims and their children; prohibit discrimination on the basis of gender and disability in the workplace and sexual orientation in education; increase the rights of crime victims; safeguard the environment and drinking water; and many, many others.

But her most important accomplishment has been one which has yet to bear fruit because since 2003 Sheila Kuehl has led the fight in the legislature to achieve true universal health care in California. In 2006, and again in 2008 she managed to get the legislature to pass SB 840, the  California Universal Healthcare Act , the first time in U.S. history that a single-payer healthcare bill had gone so far. Despite Schwarzeneggar's vetos both times, Senator Kuehl is continuing to work with advocates statewide and nationally to bring universal, affordable, quality health care to all Californians.

This dairy offers an update on the state of health care reform in California from the perspective of a former state senator and leader in single payer advocacy, a unique perspective that is enhanced in value by the fact that she is no longer in office and not running for another office.  She speaks honestly.

First: What Is Single Payer?

If you already know, feel free to skip this paragraph.  If you want more information than that given in the short description below, please go to Senator Mark Leno's website at and click on the left button related to SB 810.  You can download a fact sheet, a list of supporters, bill language, etc.

A single payer system for California, as developed in my bills and, now, in SB 810, establishes a universal health insurance system that provides every California resident with comprehensive benefits (with no co-pays or deductibles), for life.  It puts premiums, based on a small percentage of income and, for employers, a percentage of payroll,  directly into healthcare spending. It allows you to choose your own doctors, hospitals, dentists, eye care providers, and other medical services, without limiting you to a network. It ensures the best use of your money by cutting the current 25% private companies now spend for overhead to just 5%; and, through rewarding excellence and sharing efficiencies and best practices, ensures patient-centered, good quality health care for all Californians.

This program would insure that you can't lose health care if you lose or change your job.  Perhaps best of all, the plan is fully funded with the money we already spend on health care, which, last year, combining state, federal, local and all premiums, co-pays, deductibles and out of pocket expenses, totaled more than 200 billion dollars.

The bill eliminates wasteful insurance overhead, invests in electronic infrastructure that improves quality while reducing cost, emphasizes prevention and primary health care, and utilizes California's purchasing power to realize savings on prescriptions and durable medical equipment.


Well, how does this compare with the proposals of President Obama and the various congressional committees working on health care reform?

In his campaign, and, again, since his election, President Obama has said: If you like your current insurance, you should be able to keep it.  If you don't, there should be a "public option", that is, an insurance plan offered by the federal government, like Medicare, that you can choose as your insurance.  The private plans would be required to compete with the federal plan for excellence and cost.

What the final plan will look like is far less certain, as powerful forces are gathering to oppose the establishment of a public option.  The insurance companies have "offered" to accept that part of the President's plan that would require them to take everyone who applies.  The cost of that, according to the companies, however, would be that the President would have to sign off on an "individual mandate" so that everyone would be required to buy insurance--a great business move for the companies.  However, this can only work if the people have an affordable and adequate public option, which the insurance companies are trying so desperately to kill.  

So, if you consider the alternatives and feel that a single payer plan would be closer to what you would like to see, what should you do?  Here's Senator Kuehl's perspective:

1.  California's work on Single Payer can inform those developing the Public Option.

I don't think it hurts the single payer movement in California to strongly push for a public option in the federal healthcare reform bill, so long as states are allowed, in the federal bill, to adopt their own approach if it's more comprehensive.  The President has made it abundantly clear that he doesn't think a single payer program will pass Congress.  Nor does he think the country is yet ready to embrace it after the right wing has demonized the idea for so many years.

Our work in California has already had at least two very positive effects:
---Our representatives who favor the inclusion of a public option in the federal legislation report that they are hearing every day from single payer advocates, which, they say, aids them in holding the line, as they can say the public option is the very least their constituents will accept.
---Our work in crafting a more than 100-page, fully mature, single payer bill in California helps to inform the federal work in identifying approaches that make healthcare less costly, make certain it is universal and affordable, set forth a rationale for a minimum benefits package in all plans, and establish a path to a central, electronic, database.

2.  Single Payer Advocates Can Continue to Support SB 810 in California

This is critical.  It was in California that single payer went from being a pie-in-the-sky communist plot to a widely accepted and sane alternative to the rapaciousness of the private insurance companies.  Continuing to work this option here establishes the federal public option as a middle ground solution.

3.  We Can Also Lend Strong Voices to Insist On The Public Option

To shore up those in Congress and in the White House who are trying to preserve a public option in the face of a tsunami of opposition from the insurance companies, I recommend, at least, going to http// and using the action center there to make calls, write letters to the editor, sign up for events, tell stories, etc.  It works in our favor, as well, if, in every call and letter, you say that single payer makes much more sense for the country, however, if we don't get it this year, there must, at least, be a public option, etc. etc.  This helps to ratify how many single payer supporters are out there as well as adding to the voices raised in support of the public option.

If you want to be a bit more aggressive, Venice For Change and The Courage Campaign are organizing phone banks for the week of July 6th to call the members of the House Committees who are marking up the healthcare bill in Congress.  Their script includes single payer as an option and supports both single payer and the public option.  If you are interested in contacting them, let me know on my email or let them know at

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