September 21, 2007

Commentary:

Why We Need Health Care Reform in California

By J. Mario Molina, MD

The U.S. Census Bureau recently reported that the number of uninsured Americans rose to 47 million, with nearly seven million of them living here in California. If we don’t act now to address health care reform, we face the very real possibility that our health care system will collapse under the weight of the uninsured.

Yes, our state is experiencing a health care crisis, and in a crisis, bad things happen to good people. For many, the staggering numbers of the uninsured are nothing more than statistics in the newspaper. That is, until you meet someone like my friend Charlie.

Charlie works at Roy’s Coffee Shop, a hometown institution. For 31 years he has cleared the tables, wiped down the counter and brought customers steaming cups of coffee. Not long ago, I noticed that Charlie disappeared for a couple of weeks. It turned out that he had an infected toe, not really a big deal unless you happen to be a diabetic like Charlie. When Charlie finally saw a doctor, he was hospitalized and despite receiving good care, he got worse. Eventually, his toe had to be amputated. Now that he is recovering, he received a bill for $80,000.

Charlie doesn’t make much money. He pays taxes, but he is too young for Medicare. His wife cleans houses. Together, they raised a family and bought a modest home. Now, everything Charlie and his wife have built is threatened. No insurance? How could this happen? Charlie told me that he and his family have never been seriously ill, so he decided not to buy coverage offered through his employer because the premiums were too expensive.

To some, Charlie may just be another statistic, a victim of his own choices. But the fact is Charlie is a real person, my friend, and possibly your neighbor. Charlie now worries about how he will pay his medical bills, and honorable doctors and the hospital administrator worry that they won’t be paid. He might never have lost his toe in the first place, if only he had seen a doctor sooner. Without insurance, Charlie delayed getting care and now the cost of his care is far more than if he had been treated early. But, people without insurance often put off seeking care.

So what are we to do to unburden our doctors and hospital and reassure the millions of people like Charlie who lack health care coverage? The solution is a sensible, equitable health care reform plan.

Any workable solution must ensure that all Californians: (1) have access to affordable coverage and (2) participate in the health care insurance program. Everyone must be covered and no one should be allowed to “opt out.” That means that insurers must agree to insure everyone at rates that are affordable in return for knowing that everyone will participate. Universal participation means that we spread the costs over all Californians. It is not unlike requiring that all drivers have car insurance. Today, a disproportionate share of health care costs fall on the insured, who then subsidize care for the uninsured. This will require more money. There is no free lunch.

The Medi-Cal and Healthy Families programs must be expanded to cover the poorest of our citizens. In order to do this, we must increase payments to doctors and hospitals. California cannot expect health care providers to bear an unfair share of the burden. Fortunately, the federal government will match what California spends on these programs, helping to cover the costs.

For those not covered by government programs, we must find other funding solutions. A number of proposals have been made. These include requiring employers that don’t offer health insurance to put aside a percentage of their payroll for a fund to provide health care subsidies for employees. Other solutions include fees assessed on doctor and hospital revenues to help cover insurance costs. Some have even proposed increasing the sales tax. Probably no single solution will bridge the funding gap on its own. Our leaders need to engage in a serious discussion right now to find a funding solution that spreads the costs across all Californians without burdening business or individually unfairly.

All of us must share in the solution. Those of us that have health insurance cannot ignore the problem any longer. If you just ask around, I am sure you can find someone you know who lacks coverage. It might even be you.

J. Mario Molina, MD is President and Chief Executive Officer of Molina Healthcare, Inc. Molina Healthcare is a managed care organization serving low income families and children that receive healthcare benefits through government programs.

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