Schwarzenegger health system reforms

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Brilliant idea - let's tax doctors and hospitals to pay for healthcare of everyone 🙄

http://www.latimes.com/news/local/la-ex-gov8jan09,0,2093608.story?coll=la-home-headlines

Gov. seeks sweeping health system reforms
By Jordan Rau, Times Staff Writer
January 8, 2007

SACRAMENTO -- Gov. Arnold Schwarzenegger today proposed upending just about every portion of the healthcare industry in one of the country's most elaborate efforts at holding down medical costs and expanding insurance to those who don't have it.

Schwarzenegger's plan, which he publicly unveiled at noon, would require employers with 10 workers or more to buy insurance for their workers or pay a fee of 4% of their payroll into a program to help provide coverage for the uninsured.

Schwarzenegger would tax doctors 2% of their gross revenue and place a 4% tax on hospitals. He campaigned for reelection on an anti-tax platform, but his administration argues that so many more people would have insurance that medical providers would make more money.

The governor also wants to ban insurers from refusing to offer coverage to some individuals because of their prior medical conditions. Insurers would also have to spend at least 85% of their premium revenues on patient care, a move that would limit the amount companies spend on administrative costs and profits.

In an effort to cover all Californian children, including ones in the state illegally, Schwarzenegger's plan would expand the state's Healthy Families program, providing insurance to children whose parents make less than three times the poverty level. That works out to about $60,000 for a family of four.

And Schwarzenegger said his plan would require every Californian to have health insurance.

"If you can't afford it, the state will help you buy it," he said, "but you must be insured."

Schwarzenegger called the delivery and payment of healthcare in California "disastrous," noting that nearly 1 in 5 residents is uninsured.

"The problem with that is, of course, that the rest of the people who have insurance pay for them," said the governor. "Those that are fortunate enough to have coverage — we are paying a hidden tax."

Schwarzenegger spoke by satellite from Los Angeles. Doctors treating his broken leg have ordered him not to fly more than once a week. The governor will fly to Sacramento on Tuesday to deliver his annual State of the State address.

All of these ideas are sure to engender opposition from the healthcare industry and their allies in the Legislature, which must approve any plan before it becomes law.

Anticipating a hostile reaction to his plan from many quarters, Schwarzenegger said that although it appears that some people lose and others win under this proposal, in fact the whole system would benefit.

"Everyone has been left here with a better deal," he said.

But Republican lawmakers and business groups have long argued against additional requirements on employers.

Two hours before Schwarzenegger unveiled his plan, Assembly Republican Leader Mike Villines (R-Clovis) joined with a trio of small business owners in a Thai restaurant a few blocks from the Capitol to announce that his caucus will resist any plan that places a mandate on employers. He called such mandates a "job tax," and stood at a podium alongside a large poster with those words circled and crossed through in red.

"If we put any form of mandate on a business, we are seeing a jobs tax," he said. "This isn't a philosophical discussion. This is a jobs discussion. This is the difference between employees having a job and a jobs tax that says no to that."

The governor's plan matches some elements of proposals put forth last month by the Legislature's top two Democrats. All plans build on an existing system, in which 71% of California employers offer workers health insurance.

All plans also include a "pay or play" element by which employers who don't offer health benefits must pay a fee to a state agency that would then negotiate with private insurers for worker coverage.

Last month, Senate President Pro Tem Don Perata (D-Oakland) proposed taxing workers and employers to cover an estimated 4.2 million of 6 million uninsured Californians, with a requirement that all employers — even those with a single employee — offer health insurance or pay the state a percentage of payroll. Perata would also require workers to prove when they pay taxes that they have health insurance.

The plan of Assembly Speaker Fabian Nunez (D-Los Angeles) would not force workers to show they have health insurance. He would exempt businesses with less than two workers, those with a payroll less than $100,000 and firms less than three years old.

This afternoon, Nunez called Schwarzenegger's plan "pretty much in sync with the proposal I laid out in December." He also called it "a good start."

Schwarzenegger agrees with Assembly Democrats, Nunez said, on many areas, including giving all California children health insurance, requiring insurers to accept all people regardless of their health status and requiring employers to either offer health benefits or help pay the cost of extending it to their workers.

"When it's all said and done, employers in California will pay a portion of their payroll deductions toward the cost of insuring their employees," said Nunez. "That will happen."

The speaker said the governor's plan could pass the Legislature on a simple-majority vote, which would not require any Republican support.

Republican lawmakers, who are a minority in the Assembly and Senate, have a seat at the table, Nunez said. But they are out of touch with mainstream Californians, he said, when they insist that children in the country illegally get no state-assisted health insurance. And they are wrong, Nunez said, in characterizing the governor's plan as a new tax.

"I don't think . . . that the governor and the Democratic Legislature ought to roll over or steamroll the Republicans in this process," said Nunez. "But I think we need to have an honest discussion about what's a real mandate and what's not a real mandate.

"The mandate is a hidden tax of $1,200 that each of us has to pay because there are employers out there who would rather increase that rate of profit and put it in their pocket than to pay a portion of the healthcare costs of their employees," Nunez said. "That's a tax."
 
It is insane. Is there any precedent on taxing a market to simply skim an admin fee off the top to REPAY THEM a smaller percent?!

WTF is happening to government? They have gone bonkers and are robbing docs blind with both hands now.


I talked to no less than 3 surgeons today that said they are going to participate in no charity work as result of this insult.

Where is it going to end?! When the entire country of Mexico is in California?
 
I left CA years ago to avoid the taxes and just this kind of crap. I know many docs who have left and are planning to leave. I suspect this will just hasten the departures. However, CA does have an excellent tort reform provision (MICRA) that limits windfall jury awards for pain and suffering to $250K. Consequently CA med mal rates are relatively low. It is a litigious state so everyone gets sued often but not for the John Edwards type awards seen elsewhere. So, is a good med mal environment worth the abysmal tax environment? If so how much worse would it need to be before you bail out?
 
Increased tax on healthcare = increased cost of healthcare = increased insurance premiums = more uninsured.

Did I miss something, or does the governator fail to understand basic economics? Oh wait, he's in politics, of course he doesn't understand.
 
Relax! I live in CA & this plan won't fly as its written & nobody expects it to - neither the governor nor his staff!

But...what this plan does do, which none of the others that have already been proposed (about 20 on the table right now in our legislature) do what this one does - it brings all the players together to talk about sharing the burden - providers (he speaks about doctors - but in reality this is a broad term - it means all providers - from pharmacists to dentists), employers, business, hospitals, insurers (requires 85% of premiums be used on patient care - currently not the case), those representing the poor & the uninsured children, and tiers Medi-Cal recipient's benefits & links them to a finite end.

He has taken a stake from each one of them & proposed they each put forth something (oh - you all didn't read about the $2 billion which is taken from the monies devoted to the poor in our counties - so the poor lose their safety net - they're not walking away scot free either!).

He also puts forth the idea that every person should be insured (which can be rightfully debated since not all persons in the state are legal......another issue) However, this state requires universal automobile insurance - even by the illegals. But - as someone pointed out - we do provide universal coverage in this state - to 6.5 million uninsured!!!! That alone is breaking our system.

One of our issues as a state is indeed one we share with other border states - no one wants to address the cost of securing our borders...and it is costly! Daily we haul them out of trucks, scoop them from sweatshops or meet them at docks & put them in buses to be sent back across the border...but they come back the next day.

Who here has not driven up to a big box hardware store & hired a worker off the street? If you haven't nor haven't seen it, you're to be admired & are lucky because each & every one here has at least 100 men waiting for work. Why? Because someone is going to drive up & hire at least half of them by 8AM - they are daily workers, paid in cash & receive no benefits....but their kids go to our schools & get the same amoxicillin as your kids do when they get ear infections.

This is a huge problem in our state - and TX & FL & the other border states. But those of you who do not see this as a problem, don't want to address it nor do you want to fund it. However, we continually have to join in with other states to address subsidy issues such as wheat, milk or corn subsidies when those economies tank or help fund a crazy war which will have no productive outcome to anyone.

No - none of us like this answer, but none of us in CA expect this answer to fly either. But....(and this is a big BUT since I'm not a Schwarznegger fan AT ALL!) what he has done is start a dialog which FORCES all players to speak together. In this state, we must do something because the wheels are already off our system - we don't have to wait. Until now....none of the players have been willing to come together to share what they're willing to give up - perhaps now they've been scared enough to do so....or as many of you have said...perhaps specialists will leave. I'm guessing not so much! (Remember - this same governor was the only one who defied his party & the federal govt & proposed & won stem cell funding from the state's budget. I don't think those folks are going to be leaving....)

I'm not advocating this plan, but it surprisingly is one of the more conservative ones proposed & if you read commentary - from both sides of the aisle & both sides of the marketplace (business & consumer) - none of them think this is going to work as its written. It is just good dialog to begin.

What can possibly be wrong in starting a dialog????
 
This is possibly one of the worst ideas ever.

Where does the money come from? Let see:

2 billion FROM charity care that's already in place
5.5 billion (HOPEFULLY) from the federal government
forcing employers to cover insurance or pay 4%
robbing physicians 2% (GROSS earnings)
stealing from hospitals 4%
limiting insurance companies to 15% of premiums going towards profits and administrative costs... hmmm offset by the fact that there will now be 6.5 million new premiums... oh and that fact that they are already usually under 15%

So this plan in effect steals from employers, programs providing charity care, physicians and hospitals that provide charity care, and limits insurance companies to "only" 15% of every premium dollar going towards profits. Governator Schwarzenegger had 100 million dollars in campaign contributions and an estimated 4 million from health insurance companies. He is a wry politician that's deceiving the public and lining the pockets of fat cats.

Today's politicians are unethical cheats who do nothing but abuse their power to provide wealth to the rich at the cost of the poor. America spends the most amount of money for mediocre health results, we have 40 million uninsured, and one of the most sickening disparities in wealth among industrialized nations.

I am disgusted.
 
This is possibly one of the worst ideas ever.

Where does the money come from? Let see:

2 billion FROM charity care that's already in place
5.5 billion (HOPEFULLY) from the federal government
forcing employers to cover insurance or pay 4%
robbing physicians 2% (GROSS earnings)
stealing from hospitals 4%
limiting insurance companies to 15% of premiums going towards profits and administrative costs... hmmm offset by the fact that there will now be 6.5 million new premiums... oh and that fact that they are already usually under 15%

So this plan in effect steals from employers, programs providing charity care, physicians and hospitals that provide charity care, and limits insurance companies to "only" 15% of every premium dollar going towards profits. Governator Schwarzenegger had 100 million dollars in campaign contributions and an estimated 4 million from health insurance companies. He is a wry politician that's deceiving the public and lining the pockets of fat cats.

Today's politicians are unethical cheats who do nothing but abuse their power to provide wealth to the rich at the cost of the poor. America spends the most amount of money for mediocre health results, we have 40 million uninsured, and one of the most sickening disparities in wealth among industrialized nations.

I am disgusted.

We have some of the richest poor people in the world. Disparities are not bad in and of themselves. Envy shouldn't be basis of social policy. The problem is when people get rich based on the use of government, rather than by being productive and earning money.
 
We have some of the richest poor people in the world. Disparities are not bad in and of themselves. Envy shouldn't be basis of social policy. The problem is when people get rich based on the use of government, rather than by being productive and earning money.
This is something we will just have to disagree on.

In my opinion, the only people getting "rich" from the government are corporations that are already wealthy. Some homeless person selling food stamps for money isn't getting "rich" by any stretch of the imagination, nor is anyone on welfare. We are terrified of the possibility of welfare mothers driving Cadillacs, when in reality the small gains of these outliers pale in comparison to the disgusting amount of money we give away to wealthy corporations.

I agree that envy shouldn't be the basis of social policy. I believe that social policy should be geared towards a balance between freedom and the greater good. I believe social policy should take compassion into consideration. I do not believe as one of the wealthiest countries in the world, we should be comforted by the notion that our poor are the "richest poor" in the world, while the richest 1% continue to gain wealth at unprecedented levels.
 
This is possibly one of the worst ideas ever.

Where does the money come from? Let see:

2 billion FROM charity care that's already in place
5.5 billion (HOPEFULLY) from the federal government
forcing employers to cover insurance or pay 4%
robbing physicians 2% (GROSS earnings)
stealing from hospitals 4%
limiting insurance companies to 15% of premiums going towards profits and administrative costs... hmmm offset by the fact that there will now be 6.5 million new premiums... oh and that fact that they are already usually under 15%

So this plan in effect steals from employers, programs providing charity care, physicians and hospitals that provide charity care, and limits insurance companies to "only" 15% of every premium dollar going towards profits. Governator Schwarzenegger had 100 million dollars in campaign contributions and an estimated 4 million from health insurance companies. He is a wry politician that's deceiving the public and lining the pockets of fat cats.

Today's politicians are unethical cheats who do nothing but abuse their power to provide wealth to the rich at the cost of the poor. America spends the most amount of money for mediocre health results, we have 40 million uninsured, and one of the most sickening disparities in wealth among industrialized nations.

I am disgusted.

America is bar none the fattest country in the world. We are also the laziest with the lowest amount of exercise in the world. Add that up and 1 in 3 americans are obese. Considering what the U.S. public is giving us to work with Mediocre results are pretty damn good. I can go to Burger king and get a quadruple cheese burger with half a bushel of french fries and a 64 ounce coke. Our portions are completely out of control. The bottom line is this there is nowhere and I mean nowhere I would rather be if me or my family was sick. There is no other country in the world that will give me and my family more timely, high tech quality care.
 
Relax! I live in CA & this plan won't fly as its.....
What can possibly be wrong in starting a dialog????

Yeah i agree about the dialogue. How about extending that dialogue a bit to address the illegal immigrants. I find it amazing that Californians (not inferring yourself) have such contempt for illegal immigrants as to imagine that they are a drag on our economy. Nothing could be further from the the truth: California's huge economy on a global scale largely depends on the exploitation of a endless cheap labor supply. I like great produce. The produce in california is amazing, I'm pretty low on the economic ladder but I can afford beautiful California produce. I refuse to turn around and ignore whose sweat brought me the fruits of the Earth and claim that they are a drag on our resources. They contribute untold millions to our way of life and recieve scant amount of benefit from their labors in terms of social resouces. This bizarre zero sum myth I would expect from some mid-western republican twit looking for an issue of fear to ride into political office....but it suprises me to hear from people who clearly benefit from cheap immigrant labor. Everytime something gets built, landscaped, cooked, picked, delivered, cleaned etc etc in California its brought to you by your friendly neighborhood immigrant population...or should I say "those lazy terrorists."
 
This is something we will just have to disagree on.

In my opinion, the only people getting "rich" from the government are corporations that are already wealthy. Some homeless person selling food stamps for money isn't getting "rich" by any stretch of the imagination, nor is anyone on welfare. We are terrified of the possibility of welfare mothers driving Cadillacs, when in reality the small gains of these outliers pale in comparison to the disgusting amount of money we give away to wealthy corporations.

I agree that envy shouldn't be the basis of social policy. I believe that social policy should be geared towards a balance between freedom and the greater good. I believe social policy should take compassion into consideration. I do not believe as one of the wealthiest countries in the world, we should be comforted by the notion that our poor are the "richest poor" in the world, while the richest 1% continue to gain wealth at unprecedented levels.


Fair enough. I'll just point out that the majority of these corporations that make people angry are using the same tactics are used in order to get things for the poor. They claim a greater good and get "welfare." I don't discriminate. I don't think ANYONE should get welfare.

You said that freedom needs to be balanced with the greater good. I believe that freedom IS the greater good. Unprecedented wealth gain is AWESOME if wealth is being created. The problem occurs when wealth is instead stolen, either by the richest corporation or the poorest beggar. Stealing is antithetical to true freedom, and that destroys the greater good.
 
Yeah i agree about the dialogue. How about extending that dialogue a bit to address the illegal immigrants. I find it amazing that Californians (not inferring yourself) have such contempt for illegal immigrants as to imagine that they are a drag on our economy. Nothing could be further from the the truth: California's huge economy on a global scale largely depends on the exploitation of a endless cheap labor supply. I like great produce. The produce in california is amazing, I'm pretty low on the economic ladder but I can afford beautiful California produce. I refuse to turn around and ignore whose sweat brought me the fruits of the Earth and claim that they are a drag on our resources. They contribute untold millions to our way of life and recieve scant amount of benefit from their labors in terms of social resouces. This bizarre zero sum myth I would expect from some mid-western republican twit looking for an issue of fear to ride into political office....but it suprises me to hear from people who clearly benefit from cheap immigrant labor. Everytime something gets built, landscaped, cooked, picked, delivered, cleaned etc etc in California its brought to you by your friendly neighborhood immigrant population...or should I say "those lazy terrorists."

We, in CA, would love to have a national dialog on illegal immigrants!

I will grant you...there are many who are a significant force within my state who absolutely want to allow no benefits to this portion of our society, but will exploit them completely. These folks vary widely from the "they threaten our way of life" to "those lazy terrorists" to accepted business people who are "pillars" of the community.

However....it is a complex issue & one which most states choose not to help fund. Yes, you enjoy our produce & the benefits of some of the safest buildings when you visit Disneyland or SF or Lake Tahoe & have your hotel sheets laundered & your meals prepared lavishly & cleaned up without giving a thought to who might have done all the menial labor which these jobs required.

But...when the minimum wage law needs to change to allow these folks to afford to live here, or when we try to require employers who hire 10 or more people to provide health insurance or many of the other benefits many of us take for granted......people yell "unfair to business" or they're not citizens so they don't deserve it or many of the other reasons people have....

What is the source of these problems? Well...probably multifactoral, but the INS is at the core. We have immigrants who have been in the process of trying to obtain citizenship for over 10 years. They have had children here (who by their birth are citizens), they get paid a wage, pay taxes, pay their rent, buy their food & clothing & contribute to the economy...but they have no ability to have a say because they can't become citizens.

Honestly, I have no answer to the illegal immigrant issue. I do know that what we have is not working. But...I in no way am versed enough in that area to even know how to begin to fix it.....except that putting more police on the border doesn't work.

But...our schools are bulging, our ERs are overtaxed, the basic healthcare services (tb screening & tx) are not being met because these folks either don't have access or are too afraid to access it.

But....the dialog needs to be national - because these same farm workers who pick lettuce in CA will move to Idaho to harvest wheat then to Iowa to harvest corn the to GA to pick peaches then move on back here. Its a problem for all of us .... here in CA its just gotten to the point of breaking our systems.
 
Honestly, I have no answer to the illegal immigrant issue. I do know that what we have is not working. But...I in no way am versed enough in that area to even know how to begin to fix it.....except that putting more police on the border doesn't work.

But...our schools are bulging, our ERs are overtaxed, the basic healthcare services (tb screening & tx) are not being met because these folks either don't have access or are too afraid to access it.

But....the dialog needs to be national - because these same farm workers who pick lettuce in CA will move to Idaho to harvest wheat then to Iowa to harvest corn the to GA to pick peaches then move on back here. Its a problem for all of us .... here in CA its just gotten to the point of breaking our systems.[/QUOTE]

Good points. I just find the media coverage on this issue to be absolutely insane as well as the political pandering that has become the vogue. If the @ssholes who are advocating for some giant border fence really wanted to keep out immigrants they would prosecute the people that are hiring them in large numbers. But they won't do that because they know how vital they are to the economy. Powerful agribusiness and other industries would tar and feather the political career of any politican who came close to tampering with their labor supply. But like so much of the American political scene the real issues are not the issue. Its who scores the ratings and makes the right deals for power brokerage. For this reason I actually am impressed with the governor's willingness to take unpopular action towards working out a solution that none of us are going to love but that we must work on together.
 
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