Medicare for All — or whatever “free” program du jour is being pitched to solve all what ails healthcare — might strike you as simplistic or unrealistic.
It’s not that the idea isn’t noble nor is the fact it might be too expensive to pull off. The Sacramento Bee, a publication with strong roots in liberalism that run deeper than the richest vein ever in the Mother Lode, did a series of stories that concluded it would cost at least $200 billion a year in new taxes to implement a universal healthcare system in California and this is after you capture the $400 billion currently spent annually in the state by the government and private sectors on healthcare.
Keep in mind Gov. Gavin Newsom’s proposed budget for the fiscal year starting July 1 calls for a $144 billion general fund spending plan.
We currently spend 18 percent of our gross domestic product annually on health care in this nation. That comes to more than $9,892 per capita for health care — the highest of any nation. That’s based on data gleaned by the Organization for Cooperation and Development. We’re $1,973 per capita ahead of Switzerland at No. 2. Yet our outcomes are dismal as in many categories of quality of life and other health measuring yardsticks we even fall behind some Third World countries. At the same time government projections call for health care’s $3.5 trillion annual bill to grow by 5 percent annually through 2026.
The answer to this is not to throw more money at the problem and perpetuate the nuts and bolts of how we go about health care by simply making it a single-payer system without addressing needed reforms and making serious decisions that can’t be reduced to sound bites. Of course the assumption is once under government control, the healthcare system will magically be reformed in a way that assures universal and high quality care for all.
It is kind of like assuming you can improve higher education by simply opening the spigot more for student loans as an incentive for colleges to charge more to fund an education system that at the core — once you peel away tech gadgets — remains essentially unchanged after more than a century.
Personal responsibility — better diet, more exercise, and avoiding high risk activities such as smoking, drinking heavily and such — obviously are key but they are not something government can effectively regulate or incentivize. Besides if you toss in DNA, the pitfalls of living such as accidents and abuse, as well as environmental concerns there are limits to how effective personal initiative can go. People still need to have quality health care.
So what do we do?
First we should all take a deep breath and listen carefully to the sage advice of former Vermont Gov. Pete Shumlin who threw in the towel in 2014 on single-payer health care for his state.
“My critics say I abandoned single-payer because it was too expensive,” Shumlin said. “That’s not accurate. I abandoned single-payer because health care in America is too expensive. Until we get costs under control, there is no system we can afford.”
That said there are a lot of proposed fixes out there to address costs as well as the scarcity of medical care professionals in many regions. Single-payer health care per se will not address affordability nor will it target limited access caused by the lack of medical professionals many areas. There are items within the Medicare for All plan that makes sense. The problem is we can’t afford to simply collapse everything we are doing now so brilliantly expensively into one basket with less than stellar results compared to the rest of the world without making major changes.
That said there are fixes being floated to fix what ails health care that are getting little attention mainly because they are not as glamorous as the single-payer debate when it comes to controlling costs and improving access as defined by actually being able to find and see a medical professional in a reasonable amount of time.
Among solutions being advanced that have strong merit are a series of bills introduced by Assemblyman Heath Flora of Ripon.
One of those is Assembly Bill 1444 dubbed the Primary Care Student Loan Repayment Program.
Just like there are food deserts where people lack adequate quality food being available there are also health care deserts where there are acute shortages of medical personnel to care for people. Universal access that the single payer model promotes would only make it worse.
And nowhere is that truer than in the San Joaquin Valley that the University of California has determined is one of the poorest and least healthy regions of the state. The SJ Valley has about 41 percent of its population covered by Medi-Cal. A workforce assessment by the University of California, San Francisco determined the SJ Valley has a significantly lower level of health care professionals relative to other regions in California. The demand for registered nurses, as an example, is expected to grow by 35 percent over the next 22 years as the number of available RNs continues to decline. That means by 2030 the SJ Valley will be short nearly 10,000 nurses. A single-payer health care plan won’t change that.
Even in the more relatively affluent pockets of the SJ Valley awash in the overflow of more robust Bay Area paychecks held by those who seek out affordable housing, attracting healthcare professionals — especially medical specialists — is a constant uphill battle.
If you doubt that ask the administration at Doctors Hospital of Manteca how tough of a task that can be at times even with strong community growth.
The problem is enticing doctors here. When you are a freshly minted doctor or RN and you are carrying a staggering debt load you are going to look for a place to go to work that helps you pay down the debt faster as well as an area attuned to the lifestyle you believe you want.
Over the years, when Doctors Hospital of Manteca has been recruiting medical professionals they have found that once physicians and specialists see what the area has to offer, the fact it’s within an hour or so of almost every cosmopolitan and nature attraction you can think of plus it has an economy with sustained growth, they have a solid chance of snagging them.
Flora’s bill expands on existing programs to help entice freshly minted physicians, surgeons, and nurses to the SJ Valley.
It would do so by establishing within the Office of Statewide Health Planning and Development the Primary Care Student Loan Repayment Program. It would award up to $50,000 for paying down student loan debt to physicians, surgeons, and nurses who practice for two years in either a federally designated health professional shortage area or a primary care shortage area in California. The SJ Valley is one of the California regions that qualifies under both designations.
“Becoming a doctor or a nurse requires a lot of time and energy, but it also costs a lot of money,” said Assemblyman Flora. “This will be a strong incentive for health care professionals to serve in the communities that need it most. It doesn’t matter what insurance card you have in your wallet if there aren’t enough doctors.”
Flora’s bill is not the overall answer by far. It is however a carefully crafted measure to address a specific healthcare issue that can provide a measured difference.
Hopefully the California Legislature doesn’t let it get lost in the rumblings regarding single-payer proposals.
This column is the opinion of executive editor, Dennis Wyatt, and does not necessarily represent the opinion of The Bulletin or Morris Newspaper Corp. of CA. He can be contacted at firstname.lastname@example.org or 209.249.3519.