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I.
Affordability
Q. How does SB 840 provide
coverage to all Californians without
increasing spending
A. By correcting the current
health care finance system which currently spends
nearly 50% of each health care dollar on administrative
and clinical waste, excess drug prices and fraud.
SB 840 streamlines administration, uses state purchasing
power to negotiate discounts on the price of pharmaceuticals
and medical equipment, creates an agency to perform
health planning and support the delivery of high
quality care and establishes an Inspector General
for Health Care with strong investigative tools
to uncover fraud.
Q. Why is there no new spending? |
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A. There is more than enough money now
being spent on health care to finance benefit rich universal
health coverage. We spend over $6,000 per capita, or
more than twice the amount spent in other countries that
insure everyone. By correcting health care mis-spending,
SB 840 is able to direct money into health care and make
the health system very efficient.
Q. How does SB 840 control spending growth?
A. The foundation for controlling spending
growth is the streamlined administration made possible
by having a single insurer, use of purchasing power to
lower prices, provision of universal health coverage so
everyone gets preventive care, and consolidated budgetary
authority with statutory spending limits. SB 840 does all
of this and adds an array of other fiscal tools including
capital health investment management, a health payment
board to establish provider reimbursement, and a referral
policy for specialty care. If necessary, SB 840 gives authority
to impose limits on provider and manufacturer reimbursement,
to increase premiums, delay the introduction of new benefits
and delay capital investments.
Q. Can we afford this reform at a time of
budget deficits?
A. Budget deficits are caused in part by
our dysfunctional health finance system and health care
mis-spending. We can’t afford NOT to do this and
SB 840 would be a major step toward deficit reduction and
a balanced budget. The Lewin Group forecasts that a single
insurer model would save the state $44 billion dollars
in the first ten years.
Q. Will people pay more?
A. Most would pay less for health care and
insurance than they do now And, once one’s healthinsurance
premium is paid, there are no other costs, no co-pays,
no deductibles.
II. Insurance
Q. How many Californians have no health insurance?
A. About 5 million Californians have no insurance
at any time during the year, with an additional 2 million
lacking insurance for part of the year. 1.2 million without
insurance are children. A disproportionate number of those
without insurance are people of color and those with low
income.
Q. Who doesn't have health insurance?
A. More than 80% of Californians without
health insurance are in families where there is at least
one person working. A disproportionate number are from
the black and Hispanic community, and over 20% of children
have no health insurance. Many are low-wage workers, but
many are also solidly middle class.
Q. I have insurance, so why should I want
to change a system that is working for me?
A. The health care crisis affects all of
us. Last year, 2 million Americans went bankrupt because
of medical bills and most of those had health insurance.
Each year it is estimated that as many as 500,000 people
die from preventable medical errors and infections and
the misapplication of technology. The Institute of Medicine,
the government health advisor, says we are suffering from
an “epidemic of sub-standard care”. The price
of health insurance is rising many times faster than wages,
as much as 59% over the last 5 years. Employment is adversely
affected because employers avoid hiring full time employees
to avoid having to pay for expensive insurance for them.
US products are becoming less competitive in global markets
because of high employer health care costs. Emergency Rooms
aren’t available when you need them because they’re
filled with uninsured Californians who have no where else
to get care. We all have a big stake in fixing the health
care crisis.
Q. Why is it better to pay into a publicly administered
health care system than to pay a private health insurance
premium?
A. You get a lot more health care from your
contributions to a publicly financed system than from a
private health insurance premium. When you pay a premium
to an insurance company a large portion of it, 20% to 30%,
goes to administration, shareholder dividends, executive
reimbursement, marketing and to pay for additional administrative
costs borne by doctors and hospitals. Only 70% to 80% is
spent on health care. When you contribute to a state health
fund, much more money goes to provide health care. It is
a more efficient use of limited health care resources.
Q. Does SB 840 (Kuehl) cover undocumented
immigrants?
A. Yes. It costs California less to insure
undocumented immigrants than to exclude them. People without
health insurance don't get preventive care and, consequently,
use expensive emergency rooms and hospital care when they
get sick. It is estimated that if every Californian got
preventive care we could save $3.4 billion dollars a year.
Most undocumented Californians are employed in essential
jobs and our immigrants pay $80,000 more in taxes and fees
over a lifetime than they will receive in local, state
and federal benefits in their lifetimes. And it's good
public health policy to insure the entire population. It
helps control epidemics or outbreaks that could expose
everyone to disease.
III. Access
Q. What about waiting lists in Canada?
A. Canada spends about 1/3 as much as we
do per capita on health care and uses waiting lists to
manage limited resources. California spends more than enough
to avoid waiting lists, although we will have to plan our
resource use carefully.
Q. Does this reform ration health care?
A. Under SB 840 (Kuehl), care will be affordable
for every Californian, and health system planning will
be done by a public, representative Health Policy Board.
Care will only be "rationed" in the sense that
the care you get will be based on the sound medical judgement
of your doctor. All health care systems now ration care
and consider it to be sensible health care planning. The
question is on what basis is care rationed and who makes
the decisions? Today, insurance and pharmaceutical companies
and HMOs ration care and medications to those who can afford
them.
IV. Socialized medicine
Q. Is this socialized medicine?
A. This is definitely not socialized medicine,
where the government owns all the health care facilities
and trains and employs the health care workforce. This
is a private health care system that is publicly administered
and financed.
Q. Is this government-run health care?
A. No. A publicly administered finance system
will put medical decision making back in the hands of medical
professionals and their patients, unlike today when doctors
have to get permission to order a test or a treatment from
an insurance administrator with little or no medical training.
SB 840 has provisions to protect the health care system
from some of the problems that governments face. Strong
conflict of interest rules, prohibitions on partisan activity
and connections to for profit insurance and pharmaceutical
companies have been incorporated. Health system officers
are protected from special interests and the entire health
care system is exempted from oversight by other government
agencies that might slow things down and make bureaucracies
unresponsive.
What makes a government program unpopular is inadequate
funding, complex eligibility rules, means testing, periodic
eligibility lapses, poor provider participation, low provider
reimbursement and the stigma of being "on welfare." A
publicly administered consolidated insurance system will
not have these problems.
.
Q. Won't the Commissioner be a "czar" with too
much power?
A. No. The Commissioner is elected. This
provides a measure of accountability and the leadership
system has checks and balances. The Commissioner is the
chief administrative officer. A physician is the Chief
Medical Officer. The Consumer Advocate represents consumer
interests. All meetings are open. All documents, except
privacy-protected documents, are public. All system officers
may be impeached for malfeasance of office.
V. Benefits
Q. Is a full pharmaceutical benefit without
a co-pay affordable?
A. Yes. By using the state's purchasing power
for 35 million Californians, it can win large discounts
on the costs of pharmaceuticals. Californians will then
be paying what the Europeans, Scandinavians, Australians
and Canadians pay for the same pharmaceuticals and, at
those prices, pharmaceuticals are affordable.
Q. Will drug discounts adversely affect pharmaceutical
companies?
A. No. There are 10 million Californians
who now have no prescription drug benefits but who will
have them under SB 840 (Kuehl). This expansion of the market
offsets losses from lower prices.
Q. Will lower drug prices hurt the ability
of pharmaceutical companies to do research?
A. No. Pharmaceutical companies don't use
profits to pay for research, so even if their profits were
to drop from lower drug prices, it won't affect research.
Q. How will the plan help seniors who already
have health coverage through Medicare?
A. Under SB 840 (Kuehl), seniors get benefits
that Medicare doesn't cover, such as full prescription
drug coverage and dental coverage. For at least the first
two years there will be no co payments or deductibles for
ANY services. Seniors will spend less than they do now
for health care.
Q. Will anyone lose benefits they now have?
A. The intent is that no one should lose
any benefit they now have.
Q. Who decides what the medical benefits
will be?
A.The Chief Medical Officer and other physicians
recommend the benefits they think are appropriate. The
Commissioner and the Health Policy Board vote on whether
to accept their recommendation.
Q. Will Kaiser still exist under SB 840?
A. Kaiser will provide health services just
as it does today but it will no longer sell insurance policies.
All licensed, accredited providers will still exist and
may be chosen by patients through the system.VI. Quality
Q. Will SB 840 (Kuehl) stifle innovation?
A. SB 840 will stimulate innovation in several
ways. SB 840 will expand health markets, by freeing up
private dollars that now pay for care for the uninsured
and by creating a well-funded state budget for R and D.
Partnerships for Health will provide health care grants
to communities for innovative programs. Pharmaceutical
companies will have the incentive to redirect the 40% of
their research budget now spent on
“copy cat" drugs and instead invest it in much
needed research on treatments for diseases such as multiple
sclerosis and breast cancer.
Q. How will your system decrease medical
errors?
A. By eliminating many of the causes of errors
such as understaffing, lack of readily accessible medical
information, and lack of coordination of medical services.
Your primary care provider will be responsible for coordinating
the care you need.
Q. How will SB 840 address the nursing shortage?
A. No one can solve the nursing shortage
overnight. A well-managed single insurer system would,
however, have funds to invest in nursing education, the
shortage of which is the heart of the problem.
Q. Can the Commissioner close a hospital
over the objections of the community?
A. No. A hospital would only be closed if
providers and patients choose not to use it or if the hospital
fails to be accredited under California law. The Commissioner
can hold back funds if a hospital fails to meet quality
of care standards. |
