The unraveling of California’s finances, along with little hope for help from the Federal level, continuing large increases in the cost of health care, and soaring premiums for health insurance has helped to add urgency to the need to reform our health system. Add to that the soaring cost of the Workers’ Compensation system in California, and suddenly we are talking about not just the poor being hurt, but the middle class and businesses.

California Senate Speaker Pro Tem John Burton has put a priority on passing a plan to provide employer-paid health care insurance to the working poor and proposals to make workers’ compensation insurance less costly to employers and more effective for injured employees.

For the health insurance issue, a committee with Sens. John Burton (D-San Francisco), Jackie Speier (D-San Mateo) and Samuel Aanestad (R-Redding) and Assembly members Dario Frommer (D-Los Angeles),Rebecca Cohn (D-Campbell) and Rod Pacheco (R-Riverside) intends to develop a compromise bill and pass it by September 12. The bill is to be based on three "pay or play" bills (SB 2, AB 1527 and 1528) plus a universal "single payer" bill (SB 921 - see below), all of which were introduced into the legislature this year.

The pay or play bills mandate that firms provide coverage for their workers or pay the state a fee which would finance a state insurance program to cover uninsured workers. The single payer bill creates a Medicare-type program administered by the state, with expanded benefits plus reforms to improve access, outcomes, and provider payments, while reducing costs and controlling inflation. It remains to be seen how much of the reform elements in SB 921 will be adopted into the compromise bill, but just getting an employer mandate could be an important first step toward universal coverage.

The hoped-for comprehensive solution, the Health Care For All Californians Act, SB 921, authored by Senator Sheila Kuehl (D-L.A.), with six senators and 13 assembly persons as co-authors so far, passed the State Senate this spring. Hearings in the Assembly will begin in early 2004, starting with the Health Committee.

When looked at from any other industrialized country, the solution proposed by SB 921 appears far from radical. Populations in other countries already benefit from lower drug prices, lower per capita costs, lower GDP expenditures for health care, predictable coverage and cost, and comparable or better health statistics than the U.S. Are their systems perfect? No. But they give a lot more health care and preventive services to their people for a lot less money, without threatening people with financial disaster when they get sick. You can view recent comparative statistics at www.nao.gov.uk/publications/int_health_comp.pdf.

When enacted, SB 921 establishes a single health insurance plan with eligibility based on residency, period. The benefits are comprehensive, as good as or better than existing plans, and include dental, vision and pharmaceuticals. The total cost is no more than currently spent, and currently insured individuals and businesses pay less. Administrative costs are capped at 5%. Inflation is controlled and capital expenditures are coordinated. This solution inspires hope in several ways. Currently, coverage usually gets expanded for one small group. For example, patients’ rights legislation to mandate 48-hour stays after childbirth. Such expansions usually lead to higher premiums. For the poor and near poor, programs are instituted where eligibility-determination costs eat up dollars which could be used for care, and paperwork discourages those who are eligible from applying. Then, during economic downturns, just when people need help the most, these programs are cut. For those insured through work, benefits and cost vary widely, and stop-gap protections such as COBRA benefits are often unaffordable when one is unemployed.

With SB 921, the multiple deficiencies of our present health system are all addressed. Thus there is hope that we can create a predictable system that we all have access to, all contribute to, and all can afford, now and in the future.

The process which resulted in the drafting of SB 921 inspires hope as well. After the defeat in 1994 of the single payer health initiative Proposition 186, a small group of activists continued the quest for health care reform in California and in 1995 founded Health Care For All - California (HCA). With many intermediate steps along the way, HCA, working with legislators and many other organizations, got a key bill, SB 480, passed and implemented.

SB 480 authorized a comparative analysis of proposals to expand health care. The resulting Health Care Options Project (HCOP) provided evidence that a single payer system could improve the quality of health care and save money over-all, while covering all Californians. SB 921, and parts of the pay or play proposals, are a product of that study.

A small group of citizen activists has been able to hang together and plug away over a nine-year span to get major health reform legislation drafted and introduced. Now you need to become inspired to join the process of getting SB 921 passed. There has been an ongoing effort by HCA and other organizations to educate, inform, and engage the public in debate about the issue of universal single payer health care reform. Letters to the editor, commentaries, meetings, and media interviews have all been used to get the word out.

There has been a groundswell of support from a wide range of groups and individuals, from unions to consumer advocates to church social concerns committees. SB 921 has been endorsed by over 380 organizations. The members of these groups have become motivated to actively support SB 921. The result has been a large volume of letters, faxes, phone calls, and personal visits to legislators asking them to support SB 921. This past spring, organization leaders from around the State came to Sacramento, filling Senate Committee rooms to overflowing with SB 921 supporters.

This vocal grass roots support helped get SB 921 through the Senate, and will get SB 921 passed and signed in 2004. But it depends on you becoming part of the educated activist public. You need to believe in the value of this bill or you won’t work to get it passed. So learn all you can about the issue. Then work to get others involved, and to express individual or organizational support of SB 921 to elected officials. Together we can make health care for all Californians a reality.

For more information, call (805) 682-5183 or visit the website www.healthcareforall.org.