While we were “dying” in front of Senator Nguyen’s office, to show healthcare is a human right, we got the news that the finance study showing the feasibility of SB 562 had been presented in a press conference earlier in Sacramento. The news revived me because I had arrived kind of dead already after hearing that a Senate committee’s analysis projected that the plan would cost $400 billions yearly, requiring a 15 percent payroll tax. Needless to say, the study energized me to enthusiastically wave my “Healthcare is a Human Right” sign in the busy corner of Garden Grove Blvd across Costco.
Some of the organizers of the rally were young Vietnamese Americans, who made sure that the local Vietnamese press covered the event. Former mayor Bao spoke and also Ivan, who organized the rally in Santa Ana when Lou Correa showed up. Ivan mentioned Tom Daly, and when I asked him whether he meant Josh Newman, he explained to me that Daly is in the Insurance Committee, and that he also needed to be contacted.
Josh Newman had already been visited by a delegation of healthcare advocates, to request his support for this bill, and we had canvassed his district. Newman can not complain that his tenure as State Senator has not been exciting so far, between us and the re-callers…
I ended up “dying” next to a new friend I met there at the rally, Williams. This jolly fellow is a homeless man, making his living cleaning car windshields. He was walking by and decided to join us. We ended up going to the nearby McDonalds for lunch, he was very health conscious, only ordered a side salad and a cup of water. He had heard about Bridges at Kraemer and is going to call them.
Back to SB562:
“Today we released the fiscal analysis for the Healthy California Act – SB 562 (Lara & Atkins) – that shows we can save 74 billion dollars a year while guaranteeing healthcare for all! We also released a recent poll showing SB 562 is wildly popular, with 81% of Californians saying we should ensure healthcare for all and 70% saying that the Healthy California Act is the right way to do it.”
- Healthy California would save $74 billion on our current healthcare system…and cover everyone!!!
- Low and middle income households would save almost 10% on healthcare.
- ALL businesses would save money and small businesses currently paying for healthcare would save up to 22%!
Of course, life is not so simple, and a reminder of the obstacles facing SB562 was presented by this analysis of the study.
UPDATE : The Healthy California Act (SB 562) just passed out of the Senate (23 yes votes) and moves to the Assembly to continue moving forward our goal of saving billions and guaranteeing healthcare for all in California! A YUUUGE thanks to our authors, Senators Ricardo Lara and Toni Atkins, for their bold leadership that has put our communities’ health over politics.
The die-in event was covered by one of the major local Vietnamese newspapers:
Little Saigon: Biểu tình đòi TNS Janet Nguyễn bỏ phiếu ủng hộ dự luật y tế
Đằng-Giao/Người Việt
June 1, 2017
GARDEN GROVE, California (NV) – Một nhóm người, cả gốc Việt lẫn da trắng, tập trung trước cửa văn phòng Thượng Nghị Sĩ Janet Nguyễn tại Garden Grove và hô hào khẩu hiệu ủng hộ Dự Luật SB 562, một dự luật y tế toàn tiểu bang, lúc 12 giờ, Thứ Tư, 31 Tháng Năm, và kêu gọi vị nữ dân cử bỏ phiếu”
The main organizer of this event, Jessie Nguyen, sent this note to the other participants:
“Thanks Everyone!
I will need your help now more than ever. We are just at the tip of the iceberg. We are beginning to see supporters but a lot of opposition (e.g. someone has been telling the vietnamese community that this is a government controlled healthcare or it costs too much). The word communism has been used to describe this bill already. We need to dispel this misconceptions asap”
We may have a hard time dispelling this misconception. We may still have a long road to go with an alternative to the inhumane healthcare proposals of the Trump administration, but as the poll below indicates, 70 % of Californians support a medicare for all bill.
Josh Newman supported SB562, and another friend sent this note:
“ I called Newman’s office to thank him this afternoon and left my name with the anti-recall campaign: 714-882-1267. (website link http://dontsignrecall.com/)
“ FYI, Josh Newman won by only 2,498 votes with almost 300,000 votes cast, .08% of the vote!)
“ A friend actually overheard Moorlach, the Senator for the 37th district, my district, talking with some of his friends at the Costa Mesa Memorial Day event. Moorlach said, “Our #1 focus now for the Republican party in the OC has to be recalling Senator Josh Newman.”!)
So now I may be walking the streets of Fullerton again, and I may run into some friends who have made the argument to recall Newman in this blog. This is what a democracy is all about! They may share our same concerns about healthcare.
Don’t wait! Call now…and every day until SB 562 is passed!
Here are some additional resources.
- Watch the press conference – http://www.ustream.tv/recorded/103846447
- SB 562 Poll – https://tinyurl.com/PR562Poll
- SB 562 Poll Topline Results – https://tinyurl.com/562Poll
- UMass Amherst PERI SB 562 Economic Analysis Press Release – https://tinyurl.com/PRSB562FiscStudy
- UMass Amherst PERI SB 562 Economic Analysis (full study text) – https://tinyurl.com/562EconAnal
- Visuals/Flyers: Poll Flyer – https://tinyurl.com/562PollFlyer
- Household Savings Flyer – https://tinyurl.com/562HHSaveFlyer
- Business Savings Flyer – https://tinyurl.com/562BizSaveFlyer
Also check out our Facebook and Twitter for important updates!
I may be from the other side, but I have some questions:
a. 15% payroll tax will hurt minimum wage workers BADLY. I have student loans, car payment and other debts I have to take care of. I do pay around 100/mo for a subsidized silver plan, but with Lara Care I will be paying 150 bucks MORE a month. The proponents haven’t fully discussed this issue. I am not against having to pay a nominal share.
b. How will Lara and Atkins get more medical practitioners to work in California if there is no incentive for the doctors to work in our state? The Inland Valley has a medical professional shortage.
c. I used to be against the ACA, but I do support the ACA more than Trump Care or even LaraCare. I think the better solution is to fortify the ACA. It might be cheaper to have some private companies operate the policies and run them like federal student loan servicers.
Hi Matthew. The 15% payroll tax was a projection done by the Appropriations Committee. The Healthy CA study states in its website that modest tax increases would be needed:
“…California’s total spending on health care, with savings of 18 percent produced by reductions in administrative costs, the use of state bulk purchasing power, and improved patient care delivery, would drop to $331 billion. But that figure includes $225 billion of current taxpayer funded spending on Medicare, Medicaid, tax subsidies paid to insurers for health expenses of families and households.
… an additional $106 billion will be needed – replacing the huge burden of what Californians now pay to insurers and other health care corporations in premiums, deductibles, co-pays and other out-of-pocket health care costs, and the social impact that imposes for people who skip needed care due to debilitating cost.
The study proposes achieving that added revenue through two modest taxes, a 2.3 percent on gross business revenue receipts – exempting the first $2 million in receipts to eliminate the cost for small businesses – and a new 2.3 percent sales tax that would exempt all spending on housing, utilities, services, and food at home, to mitigate the impact for low and moderate income Californians. The lowest income Californians would receive a tax credit, fully offsetting their tax share.”
In regards to the your second question, another commenter asked the same question in a previous post : ” Does the bill require all doctors in California to participate? We already seem to have a shortage of doctors in California (based on my ability to get a timely appointment). Would this just push more doctors out of the state?”
I’ve asked a couple of doctors involved in this campaign to address the question.
Regarding the role of private companies, in general in the current system they are considered part of the problem. I’ll refer this question to the bill’s policy experts, for further elaboration.
Thanks for your questions.
Hi Matthew, I think the problem with private companies is the profit-motive. Healthcare and profit-based companies don’t go hand in hand. The more of one, the less of the other.
It is significantly cheaper to have the health insurance companies out of the picture completely. Why does it take them 30% to administer healthcare when Medicare does it for 3%? Private health insurance companies have to pay CEO’s and shareholders.
We really can’t afford the current system and it’s because of corporate profit-based healthcare that jacks up our rates every year.
To Mr. Munson’s points:
a. your interpretation skews the data in the reports. As I read it, only those really well off will have their healthcare costs increase and then only nominally. I can not replicate your numbers without having a clearer understanding of your data.
b. I agree with your assessment of the plan using medicare reimbursements across all areas in healthcare. It will impact the availability of healthcare in many areas. BUT there is already a shortage due to high student loan debt and high liability insurance. If the state “is now” liable for all of the healthcare, what happens in this arena? I do not see this addressed in the report.
c. A Medicare for All option added to the ACA, will go a long way to allieviate the ills of that system. The private system is all about profits and not conducive to supporting anything that is a necessity like healthcare or student loans for that matter.
Age 37, Making around 21800 a year. Currently on a silver ACA plan. Also we don’t know what dental procedures would be covered with this new system as well.
Thanks all, and specifically to address the point about physicians and other providers participating in the proposed new system, there has been ample evidence from Single Payer systems around the world that having universal access with complete freedom of patients to choose doctors, hospitals, and clinics of all kinds with significantly reduced coding and billing procedures required such as currently exists here in Medicare and Medicaid acts to increase provider participation.
Also, when public rather than private interests dictate the allocation of resources, accessibility is markedly improved especially for Primary Care and in less market intense areas such as rural and inner city communities.
For example, when Canada started it’s Medicare system in the early 1970’s many doctors unfamiliar with the many benefits did leave, but over the years fewer and fewer did, and in fact now doctors are leaving the US to go practice in Canada. And in Canada physicians in general are paid better then in the US, especially again in the Primary Care specialities.
When polled, US physicians have been generally in favor of a national health insurance system now for over a decade with those numbers rising all the time. In fact, when you poll doctors by specialty 75% of Primary Care physicians, and even 90% of ER physicians (like myself) are in favor of everyone having Medicare.
The data for these assertions are made available by the group Physicians for a National Health Program, http://www.PNHP.org. This group was founded by MD/PhD’s at Harvard Medical School of Public Health. You can choose to believe otherwise, but then you’d be choosing to deny the facts.
Thanks again!
Bill Honigman, M.D.
Thanks for the comment, Dr. Honigman.
What percentage of your patients are Medicaid?
Ryan, Dr Bill’s recent comment was meant to address your question ( new commenters are not familiar with the reply button). I believe he has recently retired as an Emergency Room Physician, and as such he may not have had directly dealt with the insurance status of the ER patients.
No biggie. I got it.
Don’t worry, I won’t run him off.
I’ll echo those thanks to all for what has so far been a pretty substantive discussion — by Orange County blogosphere standards, almost miraculously so!
This seems to be a very professional discussion and it’s a testament to you who can discuss healthcare and keep a level head. I’m in the health insurance industry and I’ll comment to those concerned about doctor’s leaving California. Unfortunately, the answer is, “it depends.” If the state can come up with a compensation arrangement that be comparable to the current income doctors are accustomed to making and can alleviate some risk or administrative burden on them at the same time, I think they’ll stay. If, however, the government uses its leverage to provide some really stingy reimbursement rates and doctors can make considerably more elsewhere, I think most will leave. Primary care in Canada, according to some very non-scientific research I’ve done appear to make around $225K per year which isn’t bad, but I’m just saying we have to look at that when we are guesstimating what will happen. The item in Healthy California that scares me is the “fee for service” payment model the bill would immediately start with until they found something else. If you have a bunch of doctors who are currently caring for the outcomes of their patients and all of a sudden they are faced with the uncertainty in the revenues from Healthy California, it only makes sense they’d be tempted to react by increasing the tests, scans, recommended visits and surgical procedures they currently conduct, that that is not good news for anyone. I’m on board with single payer, although is would likely cost me my job, but the bill needs to be modified to stay away from paying doctors on the basis of the number of “services” administered to their patients.
That seems like a fair concern. Unfortunately, I think that Sen. Stephen Glazer and to a lesser extent Richard Pan and the other two abstainers have already signaled that the bill is dead for this session, as soon as it comes back with a funding mechanism, if not before, and probably by Gov. Brown’s hand if it’s not passed quickly enough to allow the Legislature to override a veto.
I don’t expect that you’ll necessarily be out of a job, by the way, but you might end up a government employee or contractor. The state will still need good people in place to implement any such program.
Regarding the fate of the bill, I reached out to its authors and I got this response from Senator Atkin’s communications director:
“More and more, Californians believe healthcare is a basic human right. The momentum to provide universal care is building, and the moment is right to create a single-payer plan. I thank my Senate colleagues who voted to give SB 562 a chance to succeed. Let’s be clear – there is a lot of hard work to be done on this bill. There will be numerous hearings, plenty of input from interested parties and lots of time for the public to weigh in. I believe we can create a sound proposal for a healthcare system that costs less money and covers all Californians.”
A follow up regarding the process in the Assembly, whether it is similar to the Senate:
“Yes, the Assembly has the same process as the Senate. The bill will go first to the Health Committee, and possibly other committees before going to the Appropriations Committee and then the full Assembly, then back to the Senate for concurrence. In order to get to the Governor’s desk, it would have to be approved by both houses by mid September.”
Thanks again all, and I would just add that I share your concern about using a fee-for-service method of billing as currently exists in all public as well as most private plans at least that are not globally budgeted like Kaiser and other HMOs.
As an Emergency Room physician myself, I have been paid an hourly wage all of my 35+ years in practice. As I say, I don’t charge by the stitch.
But for physicians who do, this could certainly lead to over-treatments of many kinds and likely does.
However when these itemized charges and practices are overseen by public entities rather than private ones, the system is markedly more efficient with better outcomes. In fact that is exactly why Canadian Medicare like our Medicare is much better in its delivery than private insurance and approaches the quality and efficiency of the British system or our own VA system both of which are fully socialized with only salaried providers like myself.
I guess you could say Single Payer is itself a compromise but a damn good one.
Onward!
Dr Bill
Hi Dr Bill,
Same question, adjusted slightly.
In your ER, did all patients pay the same rate for the same service or did billing change based on the patient’s coverage?
I’ve been told patients with state-supported coverage, including Medicare, remit a much smaller payment to the hospital than patients with private insurance.
Thanks for doing more then your fair share to improve our culture of care.
Thanks again Ryan. I’m sorry I don’t know the answer to your question, as I believe most practicing ER physicians wouldn’t know either.
We are generally very much removed from the actual billing process. In fact, we are required by law to do an emergency evaluation and stabilization without even asking what plan the patient has unless it’s to obtain necessary medical information like a patient’s medical history.
Subsequent care involving referrals of any kind or even follow up with a Primary Care Provider is where we might need to know what coverage they have. But I could not give you any kind of fact based guess as to the percentage or the remuneration.
At one time some of us were paid as fee-for-service but nowadays I suspect that’s very very few. Otherwise we contract or subcontract by the shift and are paid by the hour.
Appreciate the honest answer.