Universal Healthcare in California

UNIVERSAL HEALTHCARE IN CALIFORNIA….Arnold Schwarzenegger unveiled his universal healthcare plan for California on Monday and it looks….okay. Just. But I’d say that about any plan that keeps insurance companies in the healthcare business, so take it with a grain of salt. Given the political realities of California and the nation, it’s probably about as good a plan as we could hope for.

(So does that mean I support it? I think so. Frankly, I go back and forth on whether cobbled-together plans like this one actually help things much, or whether they should all be opposed in favor of an eventual big bang. I may change my mind tomorrow, but for now I figure that a step in the right direction is a step in the right direction. I’ll take it.)

Overall, the plan is about what you’d expect. Basically, it’s an individual mandate (i.e., everyone is required to buy health insurance, the same way everyone who drives is required to buy auto insurance) with state subsidies for those too poor to afford coverage. There’s a new tax on doctors and hospitals, and small employers are required to either provide insurance for their employees or else pay a 4% payroll tax. Insurance companies, for their part, are required to offer insurance to everyone, regardless of medical history, age, or occupation (aka “community rating,” meaning everyone in a particular community gets the same rate.)

Problems? Sure. California Republicans are already lining up to oppose it, and this matters since tax and budget issues require a two-thirds majority to pass. (Apparently some Democratic supporters are claiming the plan needs only majority support, but this seems pretty iffy to me.) Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax. Finally, although I haven’t seen an independent analysis of the numbers, my gut tells me they look lowballed. I have a feeling the plan is going to cost more than Schwarzenegger is fessing up to.

Overall, I’m not a big fan of individual mandates. On the other hand, I am a big fan of community rating, and the whole plan might be worth passing simply to get that enshrined into law. Once community rating becomes established, I suspect there’s no going back, and that might eventually lead to a more rational system all by itself.

So two-and-a-half cheers for Arnold’s plan. It’s not perfect, but few things in life are. For now, it’s probably about as good as we’re likely to get.