This unit’s purpose is to provide local League members with information regarding Senator Sheila Kuehl’s Senate Bill 921, “The Healthcare for All Californians Act.” It would create a “single payer” healthcare system for coverage of all California residents with a single public health insurance system. LWVC supports this bill in accord with the national League’s position for a single payer system taken in 1993. Detailed information on the League’s position and on SB 921 appears below. League members who favor this bill are asked to contact their legislators and request their support.

The United States is facing a health care crisis and California seems to be leading it. An ongoing problem is that many Americans lack health insurance—currently 23% and growing because of increasing costs. A new problem is that health care costs are skyrocketing. PERS, which provides health insurance for most Californa state and local government employees and retirees, in negotiations with HMOs had to accept a 25% increase in health insurance rates in 2003 and a 17% increase in 2004. The U.S. has the best medical techniques and technology in the world, but Americans have problems accessing it due to lack of insurance, being insured by a company which too often attempts to deny care, and other problems. As a result the World Health Organization currently ranks the U.S. 37th in the world in health care outcomes. For example, among industrialized nations the U.S. has the lowest life expectancy and the highest infant mortality rates. The U.S. spends two to three times as much on health care as other industrialized nations. All these have single payer type health care systems.

The League of Women Voters and California State Senator Kuehl take the position that a “single payer” health insurance system would address the twin problems of runaway healthcare costs (cost containment) and healthcare outcomes.

What are your views on this complex subject? Look over the following list of problems often mentioned regarding the health care system of the U.S. and California. Also see the single-payer type answers proposed in the League’s position and in Senator Kuehl’s SB 921. This bill, if enacted, would create a single payer system for California. Note: In the single payer system as devised by SB 921 (and most industrialized countries, such as Germany, Canada or Japan) providers (doctors, hospitals, clinics, etc.) remain in the private enterprise system. It is claimed it will be much easier for them to get reimbursement under a single payer system than under the current system in the U.S.

**What problems in California’s health care system do you consider most serious? In addition to the list below, what problems have you experienced or occur to you?

**In your opinion would SB 921 be feasible for California? --and would it address most of these problems?

**Do you have ideas for revisions of SB 921 which might be suggested to LWVC and its lobbyist for mentioning when the bill is brought up in health committee hearings at the state legislature?

(Your unit chair could write down any suggestions and email to LWVC office at or mail to the League of Women Voters of California, 801 12th St., Suite 220, Sacramento, CA 95814.)

**Are there features of the League’s position you favor over SB 921?
**Are there features of SB 921 you favor over the League’s position?

Our Health Care System--Problems:
**Health care costs are rapidly rising in California and the U.S. Large employers in California saw their average health care costs rise 12% in 2003, and 15% in 2004. This would have been much higher if they had not passed much of the balance of the increase on to their employees. Their single employees now pay on average 35% of their healthcare premium and married employees with family pay 57%. The price of health insurance may soon be out of reach of most Americans even if offered by their employers.

**According to one study 63% of individuals’ bankruptcies are the result of medical bills.

**Almost 30% of California’s healthcare dollars are spent on administration by the many individual bureaucracies caused by the hundreds of insurers, the several thousand different insurance plans, and the dozens of government programs in California. It is estimated that a uniform health insurance system would reduce administrative costs to only 5% of healthcare dollars, saving Californians approximately $14 billion per year.

**Average health care spending per person in the U.S. is over $5000 yearly. This is 2 to 3 times that of other industrialized nations, all of which provide universal healthcare through some form of public health insurance.

**The World Health Organization ranks the U.S. 37th in health care outcomes.

**23% of Americans lack health insurance (7 million are uninsured in California) and the number is growing. Most are working people or members of workers’ families. 10 million Californians lack prescription drug benefits.

**Uninsured patients when sick often resort to hospital emergency room care. Emergency rooms are expensive to operate and are currently greatly overburdened. Moreover, uninsured patients often wait until they are seriously sick before seeing a doctor, and thus are more costly to treat. It would cost much less if these patients had insurance and access to primary care doctors.

**Many doctors are leaving California because of inadequate reimbursements by insurance companies and Medical. Medical (“Medicaid” in other states) reimbursements to doctors for procedures are among the lowest in the nation..

**Health plans often cancel contracts resulting in patients having to find a new doctor, one who does not know them or their health issues, creating unnecessary difficulties for both patients and doctors.

**The current for-profit health insurance system creates an incentive for companies to deny coverage for sick patients, to disenroll them, and to reject new applicants with “prior medical conditions”—counterproductive for an effective healthcare system.

**Inequities: Individuals working for themselves and small companies typically pay very high health insurance rates. (Large companies and institutions have strong bargaining power.)

Healthcare Position of LWVUS [for full text see www.lwv.org]

Goals: The League of Women Voters of the United States believes that a basic level of quality health care at an affordable cost should be available to all U.S. residents. Other U.S. health care policy goals should include the equitable distribution of services, efficient and economical delivery of care, advancement of medical research and technology, and a reasonable total national expenditure level for health care.

Basic Level of Care: Every U.S. resident should have access to a basic level of care that includes the prevention of disease, health promotion and education, primary care (including prenatal and reproductive health), acute care, long-term care and mental health care. Dental, vision and hearing care also are important but lower in priority. The League believes that under any system of health care reform, consumers/patients should be permitted to purchase services or insurance coverage beyond the basic level.

Financing and Administration: The League favors a national health insurance plan financed through general taxes in place of individual insurance premiums….
The League is opposed to a strictly private market-based model of financing the health care system. The League also is opposed to the administration of the health care system solely by the private sector….

Taxes: The League supports increased taxes to finance a basic level of health care for all U.S. residents, provided health care reforms contain effective control strategies.

Cost Control: The League believes that efficient and economical delivery of care can be enhanced by such cost controls methods as:

** the reduction of administrative costs, regional planning for the allocation of personnel, facilities and equipment, the establishment of maximum levels of public reimbursement to providers, malpractice reform,

** the use of managed care,

** utilization review of treatment

** mandatory second opinions before surgery or extensive treatment,

** consumer accountability through deductibles and copayments (“based on an individual’s ability to pay”),

** (“reforming the malpractice system”—in the text in a different place)

Allocation of Resources to Individuals: The League believes that the ability of a patient to pay for services should not be a consideration in the allocation of health care resources. Limited resources should be allocated based on the following criteria considered together: the urgency of the medical condition, the life expectancy of the patient, the expected outcome of the treatment, the cost of the procedure, the duration of care, the quality of life of the patient after treatment, and the wishes of the patient and family.

Equity Issues: To achieve equitable distribution of services, the League endorses increasing the availability of resources in medically underserved areas, training providers in needed fields of care, standardizing the services provided under publicly funded health care programs and insurance reforms.

State Senate Bill 921: The Healthcare for All Californians Act
[The following is edited from Senator Kuehl’s “Fact Sheet for SB 921.” The bill itself can be accessed at www.leginfo.ca.gov Click on “Bill information.”]

The Healthcare for All Californians Act would provide health insurance coverage to all Californians through a single insurance plan offered by the State of California and would control the growth of health care spending through a simplified administrative structure, consolidated financing and purchasing, and statewide health planning.

Universal Coverage: Eligibility is conferred based on residency, instead of randomly by employment. Residents traveling out of state are covered for up to 90 days. California [out-of-state] retirees with vested benefits and/or paying applicable California health taxes are covered.

Financing: THIS PLAN INVOLVES NO NEW SPENDING. The plan would be financed by a low percentage payroll tax on all employers, employees, the self-employed and recipients of unearned income, as well as a small tax on tobacco products and alcohol, which together replace private health insurance premiums. Federal, state and county monies now expended on health care would be consolidated, along with the taxes set out above, into a State Health Fund that is established in the California Treasury. There would be no co-payments or deductibles in the first two years of operation, after which the policy may be reviewed.
[Relevant quote from SB 921: “….by simplifying administration, achieving bulk purchase discounts on pharmaceuticals, and reducing the use of emergency facilities for primary care, California could divert billions of dollars toward providing direct health care and improved quality and access.”]

Benefits: Coverage would include all care prescribed by a patient’s health provider that meet accepted standards of care and practice; including medical, mental health, surgical, podiatric inpatient and outpatient services; diagnostic testing; prescription drugs and medical equipment; dental and vision care; hospice care; emergency care including ambulance; skilled nursing care after hospitalization; substance abuse recovery programs, health education and self-help programs; translation services, including services for those with hearing and vision impairments; transportation needed to access covered services.

Governance: The system would be governed by a state elected Commissioner of Health, who would head the State Health Agency. This agency would be assembled through the consolidation of the existing healthcare agencies….

Delivery of care: All California licensed and accredited providers, group practices, HMOs and integrated health care systems may participate, subject to best medical practice and cultural and linguistic standards…. Everyone would have the ability to choose his or her personal health provider….