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The San Jose Mercury News
Feb 28, 2007 - 01:00 AM

by Mike Zapler, MediaNews Sacramento Bureau

Senator to again push single-payer health plan;

SACRAMENTO, CA -- If legislative Democrats had their way, California might well be headed to a government-run health care system. Both houses of the Legislature passed a bill last year to create a so-called "single-payer'' system, only to have Gov. Arnold Schwarzenegger veto it.

Undeterred and surrounded by union supporters and fellow liberal lawmakers, the leader of the single-payer movement, Sen. Sheila Kuehl, D-Los Angeles, announced Tuesday that she's trying again. With Schwarzenegger still wielding a veto pen and pushing his own sweeping health reform plan, Kuehl is under no illusion about the likelihood of success this year.

But she's convinced the current insurer-based health system is beyond repair, and that more people will come to agree with her solution as premiums continue to rise and benefits shrink.

"If I can't convince this governor,'' Kuehl said at a news conference, "I'll work on the next governor.''

Kuehl's central goal in Senate Bill 840 is to eliminate health insurance companies -- which she says ring up excessive profits and offer substandard coverage -- from the system. Instead, she would create a new state mega-agency to administer health care to all residents -- deciding what types of treatments and technology to employ and how much to pay doctors and hospitals. Those decisions would be made through what she calls a ``democratic process'' within the new state agency, after receiving input from medical professionals and consumers.

Critics liken the approach to "socialized medicine,'' conjuring up images of rationed care and long waits for a doctor's appointment. Kuehl contends it would actually improve care and save billions of dollars.

People would be able to choose their doctors, she said, without worrying if they're part of a health plan network. Doctors would compete for customers based on the quality of their care. And the state, Kuehl said, could use its leverage to negotiate lower prices.

"This represents the gold standard for health care reform,'' said Kuehl, the chairwoman of the Senate health committee.

Health insurers and others disagree, saying that a gigantic state bureaucracy to administer health care would invite its own set of even bigger problems.

"California generally has the right approach,'' said Nicole Kasabian Evans of the California Association of Health Plans, "but needs some improvements that make coverage more accessible and more affordable.''

The health care debate in the Legislature this year is expected to focus on how to improve the current employer-based health care system, not disband it as Kuehl proposes. Schwarzenegger and the Democratic leaders of the Senate and Assembly all have proposed plans that include mandates on businesses to provide insurance for workers or pay into a state insurance pool.

Democratic legislative leaders backed Kuehl's single-payer proposal last year, but, in hopes of crafting a compromise with Schwarzenegger this year, are taking a different approach.

Still, Kuehl believes that her plan -- which would be financed primarily by a tax on workers and businesses -- will eventually prevail. She noted that the policy journal Health Affairs reported last week that health care spending in the United States will double over the next decade, gobbling nearly one out of five dollars that Americans spend. Moreover, the share of total health spending paid by federal, state and local governments is expected to grow to nearly half. Those trends, she said, are unsustainable.

"I frankly think,'' Kuehl said, "that everything is on its way, or could be on its way, to the enactment of a single-payer system."

Contact Mike Zapler at or (916) 441-4603.

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