September 29, 2009

What took the wheels off health care reform in California

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Two years ago in California, Gov. Arnold Schwarzenegger launched a high-profile campaign to remake the state’s health care system and extend health care to millions of uninsured Californians.

The buzz was strong. Initially, business and insurance interests that had opposed reform in the past supported the effort. But as details emerged that interest groups could rally around, support eroded, opposition hardened and special interests gathered strength and shot the effort down, writes Mike Zapler of the San Jose Mercury News.

It’s remarkably similar to what’s going on today in Washington, D.C. In fact, the similarities are “downright eerie,” Zapler writes. It’s a cautionary tale, and one that the Obama administration can still learn from, veterans of the Schwarzenegger era advise.

“The conversation should be about people’s health,” said Daniel Zingale, a former health care adviser to the California governor and the chief architect of his reform proposal. “Resist getting pulled into the age-old civil wars … over the narrow financial interests of the key combatants that tend to drag down every debate over health care reform.”

Obama and Schwarzenegger were after the same prize:  a requirement that everyone obtain insurance, mandates on employers to provide coverage or pay into a government pool, and subsidies to help lower-income people afford care.

“And both the governor and the president had to deal with stiff opposition from Republicans empowered by supermajority rules that gave them power beyond their numbers,” Zapler writes.

So what can Washington learn from Sacramento’s failure? The advice to Democrats from veterans of the California health care battle is simple: Stay united, accept compromise. 

Also pulling at the fringes are the ideological debates that threaten to destroy public support for basic tenets of health care policy. When debate over health care coverage gets caught up in ‘death camps,’ or ‘abortion on demand,’ the opponents have won the day. We saw that earlier when the debate erupted into shouting matches over death camps at congressional town hall meetings, and that’s happening now with abortion, as InvestigateWest wrote about two weeks ago, and the New York Times takes note of today.  Seems abortion opponents in Congress want to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. Enough moderate Democrats support the opposition that outcome is too close to call, the Times reports. This despite the fact that nearly half of those with employer-sponsored health care coverage currently have policies that cover abortion, according to a study by the Kaiser Family Foundation.

— Rita Hibbard

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