Public Option Remains Health-Care Reform Hurdle

As the health-care debate continues at full throttle, many people in resource- and cash-strapped California are trying to figure out just how federal mandates impact the state where 37 percent of people are uninsured. A June 19 panel at the Commonwealth Club ("California Health Care and the Stimulus: The Promises, Possibilities, and Pitfalls") hosted four key players in the overhaul of the system, who weighed in on the need for a fundamental shift in not only action, but in thinking and planning.

“We want reform that is sustainable, that is long-term, that is not something short-lived that’s going to make everyone feel good and then in a year we find that we’ve failed on it,” Elizabeth Imholz of the Consumers Union told the Commonwealth Club crowd. “I think if there’s ever been a moment, this is it.”

And the proverbial ball has started rolling, albeit fraught with some snags. The fiscal stimulus package infused California with a huge amount of cash in February, increasing the federal medical assistance percentage (FMAP) for Medi-Cal, which introduced the idea that the veritable down payment on health care could be an economic boon. However, the budget cuts made in July to close the massive, $24-billion budget deficit equaled a $1.4 billion slash to Medi-cal, which serves 7 million people. Currently, Medi-Cal serves as the state’s de-facto “public option,” for those who qualify; cutting it would require an even larger effort to essentially start from scratch.

As the federal health-care bill continues to work its way through Congress, California’s cuts usher some provisions of the bill to the forefront. States will be required to expand their health-care programs to more of the uninsured, even though federal funding for such programs by 2015 will be dramatically scaled back. All major health-care bills moving through Congress would use Medicare as a vehicle for expanding coverage, adding perhaps 11 million people, a 20-percent increase.

“Medicare, which we’ve all relied on [or, our parents have] for a very long time, will go broke in about eight years at the current rate of spending and the current rate of revenue coming into it,” said David Lansky, president and CEO of the Pacific Business Group on Health. “To make Medicare sustainable -– if we don’t do any healthcare reform –- someone has to find about $13 trillion to put into the trust fund.”

President Obama has received criticism for uncertainty over whether his plan will include a public option for the uninsured, and those currently dependent on Medicare and Medicaid have few other options. Further complicating the issue is the perplexing fact that the system is currently without a designated administrator. How can the debate continue without this crucial position? Medicare and Medicaid crucially need someone who is working with Congress and preparing for a possible new, expanded role.

As Dr. Cortese of the Mayo Clinic recently told The New York Times, Medicare is, in effect, the nation’s largest insurance company and the president and Congress function as the board of directors. Former Medicaid director Vernon K. Smith says an administrator is needed to address the “future fiscal stability of the Medicaid program.”

While the debate continues, the numbers of uninsured are not decreasing. Employer-provided coverage doesn’t always provide the reassurance it did in the past because of uncertainty over employment during the recession. People who have lost their jobs -- as nearly 64,000 Californians have -- and their coverage along with it may be looking to none other than Medi-Cal as a provider.

“More and more people -- as we sink deeper into the recession -- are going to become eligible for Medicaid and going to need those services,” said Imholz.

If the stated goals of a new health-care system -- reducing the cost of health care, ensuring quality insurance service for consumers, providing affordable coverage to uninsured, and not adding to the deficit -- are to be realized, some observers are saying that is will be necessary to streamline the systems already in place.

“One of the other major components of the [proposed] framework ... is an expansion of the Medicaid program as well as increased payment to Medicaid providers,” said Toby Douglas, chief deputy director of the California Department of Public Health. “It could be a very good thing, but it brings up the question of who’s going to pay for it.”

Opponents of government-run health-care worry that if it is provided, tens of millions of Americans would leave their employer-provided coverage for the cheaper public option, in turn bankrupting the federal government. More market-oriented approaches were broached at a June 11, 2009, presentation at The Commonwealth Club. [See the video here.]

At the panel discussion on overhauling the system, Douglas further explained that all parties -- on the right, the left and elsewhere -- must stay involved to hash out a solution. “There is discussion that can be built on that type of framework,” he said. “But it also isn’t clear exactly when people talk about a public plan if they are talking about that local, state public plan or more of a national one, and that’s what really needs to be worked out more in detail.”

– By Heather Mack

Barbara Lee on What Fuels Her Fire for Change

The desire to make a difference in the world came at an early age for Congresswoman Barbara Lee (D-CA). “My life has got to be about changing things,” she wrote in her diary as a girl of only 13. In her new book, Renegade for Peace & Justice: Congresswoman Barbara Lee Speaks for Me, she wrote about growing up in segregated El Paso, Texas, where African Americans made up 2 percent of the population. The congresswoman said she was very young when she was made aware of the injustices many Americans faced and became determined to help rectify them.

In an August 17 conversation with Belva Davis, a Bay Area news veteran and host of KQED’s “This Week in Northern California,” Lee shared with a Commonwealth Club of California audience the story of her birth, and stated that her passion comes from “almost not being born.” She revealed that her mother, who was scheduled to have a c-section at the local hospital, was refused admittance because of the color of her skin. “The story confused me as a girl,” she said. “I began learning about racism at a very early age.”

Lee moved to California when she was 13 years old, and she attended Oakland's Mills College, where she was elected president of the Black Student Union. Lee told the story of a political science course she took while at the university, for which she was required to work on a presidential campaign in order to pass. However, “I didn’t believe in any of the candidates,” she said. “I told the professor I would rather fail than support someone I didn’t believe in.”

Yet, that all changed when Shirley Chisholm, the first black woman to run for president, visited her campus. Chisholm inspired Lee, who was previously unregistered to vote, to become active in her campaign. As a result she “passed the class with an A, registered to vote, and basically founded Chisholm’s campaign in Northern California,” she said. “The rest is history.” Lee also credited her predecessor, Rep. Ron Dellums, with her successful run in 1998 for Congress’s 9th District, a constituency she called “the most enlightened in the country.”

She chronicled her rise from being a young, single mother of two, working for the Black Panther Party’s Community Learning Center to one of Congress’s most progressive voices. As congresswoman, Lee has taken on causes in both the United States and abroad. She said she believes her political career has become defined by her personal experiences, and she explained why she strives to speak for those in need of a voice in Washington. From the HIV/AIDS pandemic to the genocide in Darfur, Lee has fought what she called the grossest injustices of our time.

Lee is now tackling health-care reform head-on, and she has been very vocal about her support for President Obama’s health care proposal. “You have to go against the grain if you want to take on the status quo,” she said. Over the weekend, Lee, who also chairs the Congressional Black Caucus, issued a statement noting that "the Congressional Black Caucus remains committed to ensuring that health reform is meaningful, and that means making sure that a public option is part of the package." The proposed health-care option has become one of the most contentious elements of legislation taking shape in Congress, with critics maintaining that it is a step toward a federal takeover of health care and supporters arguing it is essential to create competition with private firms.

Rep. Lee said that she has visited Cuba on a number of occasions and believes that the United States could greatly benefit from studying their comprehensive health-care system. She was adamant that the embargo must be lifted, as she believes it has only served to isolate the United States, rather than Cuba. “I think we’re moving forward,” she said. “But it’s not fast enough.”

Another cause about which she is passionate is the genocide occurring in Darfur. She has visited the war-torn impoverished country on three occasions, and she stated that she believes that she can’t relinquish her activist role on this issue, even though it did result in her arrest in 2006 during a protest in Washington, D.C.

The congresswoman garnered national attention in 2001 when she was the only member of Congress to vote against a resolution granting President George Bush almost unlimited authority to declare war against nations he deemed responsible for terrorism. Lee, who has become one of Congress’s most vocal opponents to the war in Iraq, has long promoted policies that she believes foster international peace, security and human rights.

--Commonwealth Club Media and Public Relations Department