California Health Care Options Project
<http://www.healthcareoptions.ca.gov/>http://www.healthcareoptions.ca.gov/
"An estimated 22 percent of Californians do not have health care coverage. The Health Care Options Project (HCOP), led by the California Health and Human Services Agency (CHHS), is designed to examine various reform options for extending health care coverage in California. The project is consistent with the objectives of Senate Bill 480 signed by the Governor in 1999.
"Nine reform option papers have been developed for HCOP. They include public program expansions, individual and employer tax credits, employer and individual mandates, single payer models, and combination approaches. Two-page summaries and drafts of these proposals are available in the document library of this website. The reform options will be analyzed and compared using a micro-simulation model developed by The Lewin Group under a contract with HCOP. This model is also available in the document library for your review and comment.
"We encourage readers to review these materials and send comments to HCOP at
The link for the HCOP website: <http://www.healthcareoptions.ca.gov/>http://www.healthcareoptions.ca.gov/
The brief summaries of each proposal: <http://www.healthcareoptions.ca.gov/Summaries_112601.pdf>http://www.healthcareoptions.ca.gov/Summaries_112601.pdf
The comment sheet for providing feedback: <http://www.healthcareoptions.ca.gov/webcomments.pdf>http://www.healthcareoptions.ca.gov/webcomments.pdf
The index to the entire HCOP document library, including preliminary full drafts of each proposal: <http://www.healthcareoptions.ca.gov/doclib.asp>http://www.healthcareoptions.ca.gov/doclib.asp
Comment: You can be a part of this landmark study designed to examine various reform options for extending health care coverage for California, and for the entire nation, since the results of this study will establish a rational basis for reform in all states.
If you are pleased with the status of health care in this nation, then ignore this message and go watch "John Q." If you believe that efforts must be made to improve our system, then you should participate in this process. It will require some work on your part. But this is finally an answer to the question heard at all health care reform meetings, "What can we do?" What we can do is make this effort to understand various alternatives for reform and then provide an informed input to the process. The various proposals are still being refined. The authors will consider all input during this process.
The remaining comments in this message may reflect my personal bias as a contributor to one of the options, the single payer proposal of James G. Kahn, et al, of the University of California at San Francisco (Kahn, Bodenheimer, Grumbach, Lingappa, Farey and McCanne).
Two single payer proposals (James Kahn, et al, and Judy Spelman) and a health service proposal (Ellen Shaffer) are unique in that they would provide comprehensive health services for everyone. The remaining proposals are best labeled "other proposals," although some might wish to call them "incremental." They are a mix of current concepts for expanding coverage, using a variety of mechanisms, resulting in significant differences in the degree to which they accomplish expanded coverage.
Of the "other" proposals, one that I would single out is the proposal of E. Richard Brown and Richard Kronick. Of the proposals that build on our current system, theirs is the most effective and most comprehensive of the choices. It introduces policies that would provide significant improvements in our dysfunctional system. It should appeal to many of those who insist that reform must be incremental, even though some might classify this as more than simply incremental.
But look at some of the reasons that the single payer and health service options should receive very serious consideration:
** They cover everyone.
** They include virtually all beneficial health care services.
** They effectively remove financial barriers to care, an increasing threat to access today.
** They establish equity in health care: equity in funding, equity in access, and equity in allocation of our health care resources.
** And for those that always want to know what the bottom line is in costs, the tentative analysis by John Sheils of The Lewin Group, presented at the symposium in Manhattan Beach on February 8, has demonstrated that all of the "other proposals" will increase health care costs, whereas the three universal proposals will decrease health care costs for California, by billions of dollars.
Although the project is not completed, one conclusion is already clearly evident. These proposals that reduce health care costs attain virtually all of the goals of an ethically-based health care system, whereas all of the proposals that fall short of these goals will increase health care costs.
The proponents of universal coverage should no longer tolerate being left out of the symposia, forums, press conferences, negotiating processes, foundation health care reform projects, or any other arena in which the future of our health care system is being debated. We should let the exclusive club of incrementalists know that we will accept invitations to join in on the process. But, in the absence of such civility, we should considering breaking down their doors. On behalf of all patients, present and future, our voice must be heard.
Don McCanne, M.D. President, Physicians for a National Health Program www.pnhp.org
Robert Isman, DDS, MPH, responds to the California HCOP proposals:
One of the shortcomings of both your proposal and the one from Rick Brown and colleagues is that they both claim to be "comprehensive" in scope, yet neither deals comprehensively with dental services. In your proposal, at least according to the summary that was distributed at the public hearing held in Sacramento a couple of weeks ago, and not answered in direct questioning of Jim Kahn, dental and vision services appear to be almost an afterthought, and will be covered "as the budget allows." In the Brown et al. proposal, all health care coverage is said to be included for those who do not have current health coverage. The problem with that is that 1) children who would otherwise (i.e., by virtue of family income) be eligible for Healthy Families (California's SCHIP program), but who have medical insurance but not dental insurance are not eligible for Healthy Families, and presumably would also not be eligible for coverage under this plan; and 2) people covered by Medicare would not be covered by the Brown et al. proposal because they already have coverage, but Medicare does not include dental coverage.
Lack of dental coverage is the most pressing access problem in the US. For every child uninsured for medical care, there are 2.6 uninsured for dental care. About 30% of children who have medical coverage have no dental coverage. As most insurance is employment-based, when people retire, most are covered by Medicare, but as noted above, Medicare doesn't cover dental care. For every age group, access to needed dental care is cited as a reason for unmet health care needs several times more frequently than access to needed medical care, prescriptions, glasses, or mental health care.
We need to stop looking at insuring different parts of the body with different types of coverage. This situation is perhaps best captured in a statement made by the Coalition for Oral Health during hearings on the ill-fated Clinton health plan:
"Imagine waking up one morning with an excruciating pain in your hand, going to your physician, and having her tell you that you have an abscess on one of your fingers. 'I can treat it,' she says, 'but I'm afraid your health insurance won't cover it. They don't cover finger problems.' Most of us would think this was a pretty strange form of health insurance. If, as most of us now believe, exclusions based on pre-existing conditions, age, and occupational category are wrong, why should we accept exclusions based on parts of the body?
"That is exactly the situation that exists today with respect to oral health care. The mouth is not considered part of the body. While we would be appalled at excluding limbs and organs from coverage, we seem to accept most casually the exclusion of the entire human mouth. If you have an abscess on your leg, your arm--even your face--no problem, you're covered. If that abscess happens to be in your mouth, inches from your brain, you're out of luck. This is not rational."
Comment: Jim Kahn's silence in response to the question about dental coverage is similar to the long period of silence by Jack Benny when asked during a holdup, "Your money or your life?"
After being asked a second time, he responded, "I'm thinking, I'm thinking!"
Well, Jim was thinking, and he brought the dental and eye care issues back to his writing team. Dr. Isman's comments are deeply appreciated. He can be assured that Dr. Kahn's team is revisiting this extremely important health care issue.
Not only does the California Health Care Options Project provide a spectrum of reform proposals, it also provides mechanisms for public input, both through the symposia such as the one in Sacramento mentioned by Dr. Isman, and through the process for public comment mentioned in the earlier message. This time, the public really does have input into the process. Do not miss this opportunity to be a part of the process.
<http://www.healthcareoptions.ca.gov/>http://www.healthcareoptions.ca.gov/