Page 22 - Sonoma County Gazette - January 2020

Thinking About Health
Big Questions about Health Care accessible to All
By Trudy Lieberman, Community Health News Service
In recent days, several tweets shared ominous news about the state of health
insurance in the country. One tweeter said her 59-year-old friend would be paying $900 a month in premiums with an out-of-pocket maximum of $8,150. The friend has assets, but the insurance restricts where she can get care.
Dear Readers: As part of my annual year-end tradition, I am highlighting some of the new California state laws. Keep in mind that during the 2019 Legislative Session, hundreds of Assembly Bills (AB) and Senate Bills (SB) collectively passed. Governor Gavin Newsom signed 870 of the 1,042 bills that landed on his desk (he vetoed the remaining 172 bills).
A third tweeter was disgusted with his job-based coverage, which he told the world was his fifth insurance plan in four years. That’s not an uncommon complaint among workers with employer-based coverage. The man’s daughter has Type 1 diabetes, and the constant switching of doctors and plans was disruptive and hardly optimum for her health. It’s time to disconnect health insurance from the job, he tweeted.
Below is only the tip of the iceberg. When possible, I have referenced the bill number. If you want to read the full text of the new law, go to http://leginfo. legislature.ca.gov , click on “Bill Information” and then enter the bill number.
The tweeters were fed up with the price of coverage and were having trouble either paying for it or accessing care. At the crux of their dilemma is the relentless rise in medical prices along with America’s inability or unwillingness to provide health care to all its citizens and to establish a mechanism that can finally put the brakes on relentless price increases.
GUNS: 2019 was another violent year, marked with senseless shooting deaths. California continues to creatively deal with gun violence ( let us hope Congress develops the same back-bone) by passing at least two important gun-related bills. Californians are now limited to purchasing one long gun per month (SB 61). Also, in the past only law enforcement and immediate family members could seek a Gun Violence Restraining Order (“RO”) against a person who they suspect exhibited the capacity to kill with a gun. Now, under AB 61, starting September 1, 2020, schools and employers may now also seek a Gun Violence RO.
As Americans grow more dissatisfied with their insurance
arrangements, public discussion about the wisdom of switching to a system sometimes referred to as Medicare for All has grown. What’s not been discussed, however, is how providing health care for everyone and controlling prices are interrelated.
HEALTH: For those who are eligible for Obamacare/Covered California, enroll NOW. The enrollment deadline was extended from January 15th to January 31st...time is running out. Undocumented immigrant children are already eligible for low income health insurance. Under a new law, undocumented immigrants under 26 can also enroll, if they meet income requirements.
New U.S. spending data show that the U.S. spent $1 trillion more on personal health services in 2018 than in 2008. Hospital care accounted for 44% of the increase, physician services 23 percent and retail prescription drugs only 9 percent. With increases like those, dissatisfaction is bound to increase.
The contentious medical exemption for childhood vaccines finally passed (SB 714). The new law tightens the medical exemption by giving the CA Department of Public Health the authority to investigate any doctor who issues more than five exemptions in one year; schools that fall below a 95% immunization rate may be “red-flagged” by state public health officials.
But in the current discussion of Medicare for All, one New York Times columnist argued that the moral and political case is now stronger for focusing on issues other than health care – the discussion has focused on why such a change won’t work: how it will harm big stakeholders; how much it would cost; and that Americans are satisfied with current arrangements.
Lastly, college students who attend public universities, starting in 2023, may now have access to an abortion pill (SB 24).
It is the fear of controls on prices, which other advanced countries have, that has kept the U.S. from changing its system for decades. If every American were in the system, including the 30 million who have no health insurance, it might make it easier for federal regulators to control prices, which is what big stakeholders fear. It is the primary reason the idea of Medicare for All, or an equivalent plan, has never advanced very far.
CONSUMER PROTECTION: Before, consumers who took out loans from $2,500 to $10,000 could be subject to outrageous interest rates, some as high as 200%. Now, under AB 539, those predatory lending practices are curbed, with interest rates capped at 36% (which is still quite high in my mind). Ralph Nader would be proud. A step in the right direction.
ROADKILL: Ideally, we all slow down (especially on our West County roads) and hopefully never hit a deer or other wildlife. But, sometimes that collision with wildlife happens. Now, under SB 395, California has adopted a pilot program that allows for the driver (or passing motorist) to apply for a “wildlife salvage permit” within 24 hours of the “kill”, so that the carcass does not waste away. Some call this new law “Kill and Grill”. For my sensitive vegetarian readers, let’s imagine a world of “Plant and Less Rant”.
PROFITS BY PRISONS: If any of you are bold enough to admit that you
have a family member or friend in state prison, then you already know the drill with private prisons. Everything, everything is “marked up” for profit...from
a simple stamp to canteen food. California has now passed the first bill of its kind in the nation (that I am aware of) that in essence requires the state to cut all ties with private, for-profit prisons by 2028 (AB 32). A huge and long-overdue step in my mind. Now hopefully the California state prisons can concentrate
on rehabilitation, as was originally intended, in lieu of making money to please Wall Street and stockholders.
In closing, my heartfelt gratitude to my loyal readers, my Editor, Vesta Copestakes, and this forum which offers an opportunity to enlighten and hopefully inspire our community on legal issues. I have had the honor of being your legal columnist for over 10 years (may be longer...easy to lose track of time). I look forward to continuing our joint mission of creating a Joyful and Peaceful 2020. May it be the Year of Clear Vision toward a world that works for everyone.
Should America provide health insurance for every citizen?
The concept of solidarity – a unity based on a community of interests, objectives, or standards – is the basis for the health systems in most European countries. It also undergirds our own Social Security retirement and disability programs, workers’ compensation, and, of course, Medicare.
When it comes to health care, there is still no universal embrace of the concept of solidarity. But unless Americans agree that every citizen is entitled to medical care and a way to pay for it, this round of discussion about Medicare for All is as likely to fail as all the previous proposals.
But what about Obamacare, you might be thinking? Remember when the former president told us his health plan would bring “affordable, quality care for all”? The Affordable Care Act established the principle that everyone should be able to buy health insurance regardless of preexisting health conditions, but it did not take the further step of guaranteeing everyone the right to medical care and a way to pay for it.
“Winning the argument about universal coverage first is really important,” says Joel Kutzin who heads the health care financing team at the World Health Organization. It’s the prerequisite to solving the insurance cost and service problems the three unhappy tweeters shared with the Twitterverse.
Should every American have the right to affordable health care?
Write to Trudy at trudy.lieberman@gmail.com.
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