Can Universal Care Cure State’s Ills?

Retired cardiologist Dr. Robert Peck remembers the 40-year-old uninsured patient who was admitted to the emergency room of a local hospital with severe chest pains. The patient was stabilized, but required further treatment. Since he had no insurance, he was to be transferred to one of the county hospitals that serve the uninsured. But the patient died while awaiting transfer.

Another patient, who did have insurance, was awaiting tests after being stabilized for chest pains.

"The gatekeeper for that HMO … not a cardiologist … decided that this man didn’t need an angiogram or even to be in a hospital," Peck recounted. "And so he sent him home."

Three months later, the patient returned to hospital with chest pains and died in the ER.

Peck’s examples and a litany of statistics clearly demonstrate the failure of California’s health care system: Of the nation’s 43 million uninsured Americans, 6.5 million are Californians. That equates to roughly one of every five state residents. Within the last decade, 15 percent of the state’s emergency rooms have closed due to skyrocketing costs. Nationally, Health insurance premiums rose almost 14 percent last year alone.

State Sen. Sheila Kuehl (D-Los Angeles) believes she has a cure for the health system’s ills. Kuehl authored SB 921, a bill that would establish a single health plan for every resident in California. Under the proposed single-payer universal health care system, individuals would choose their own health care provider and everyone would be entitled to the same benefits. But instead of being paid by insurance companies or individuals, providers would be reimbursed by the state. The state fund would be financed by a tax on employers and individuals, who would no longer pay insurance company premiums, co-payments or deductibles. Medicare, Medi-Cal and other public monies spent on health care would be rolled into the fund.

"Our health care system in California is very fragmented and grossly ineffective. There is more than enough money to provide every Californian with benefit-rich health coverage without spending any more money," said Kuehl, speaking March 18 at an event hosted by Zay Gezunt, The Jewish Coalition for Healthcare for All, sponsored by the Workmen’s Circle/Arbeter Ring, Progressive Jewish Alliance, The Sholem Community, Health Care for All, Jewish Labor Committee, The National Council of Jewish Women — Los Angeles, The Kalsman Institute on Judaism and Health HUC-JIR, Kehillat Israel, Society for Humanistic Judaism — Los Angeles, Jewish Reconstructionist Federation and Leo Baeck Temple.

"We spend about $150 billion per year on health care in California…. No new spending would be required to cover everyone if we get administrative costs down," Kuehl said.

Kuehl’s office estimates that there are more than 10,000 health benefit plans in California. And a study by Harvard researchers, reported in The New England Journal of Medicine, found that administrative costs acounted for 31 percent of health care expenditures in the United States.

Proponents of SB 921 say consolidation of administrative costs alone would save an estimated $14 billion in the plan’s first year. They also project a savings of $4 billion in prescription drug and durable medical equipment costs, which would be generated by the state’s bulk purchasing power. Further savings are anticipated from a decrease in emergency room visits, which would be curtailed once uninsured individuals had access to preventive care.

Kuehl points out that other countries with universal health care systems have better health outcomes. For example, the United States is ranked 37th in health outcomes and consumer satisfaction by the World Health Organization, despite spending more than $4,000 per person — more than any other nation — on health care annually. No. 1 ranked France spends about half that amount.

"This approach has some real legs," said presenter E. Richard Brown, director of the UCLA Center for Health Policy Research, speaking at the health care forum. He believes the bill represents "the opportunity to make some real change in this state and set a model for the United States."

Not everyone agrees.

"To someone who hasn’t been in health care or administered health care programs, it sounds attractive, but I’ve never yet seen a case where the government can run any health care service successfully," said Dr. Joel Strom, a dentist and the president of the Los Angeles chapter of the Republican Jewish Coalition. "After years of participating in the paper-filled and heavily regulated state-run Denti-Cal program, I elected to deliver free care to some patients rather than continue in the heavily regulated program. When you have a program that’s paid for by the government, they’ll go back to taxpayers all the time.

"The promise of unlimited health care for everyone just cannot be kept," added Strom, who sees insurance reform as a preferable option.

In the meantime, the Legislature has passed SB 2, a bill phasing in requirements for employers with more than 50 employees to provide health insurance or pay into a fund to finance it. However, a November ballot initiative seeks to repeal the new law before it has a chance to go into effect.

Kuehl’s bill faces a formidable set of obstacles, including the requirement of a two-thirds vote for passage. It has a natural opponent in the health insurance industry, which is well-financed to fight the bill. In addition, Anthony Wright, executive director of advocacy group Health Access, notes that the notion of a tax could prove problematic. "Even though people will save money … opponents of health reform will demonize it as a tax increase," he said.

While experts on both sides agree it is unlikely that the bill will pass this year, supporters remain optimistic.

As Kuehl staffer Emily Gold told The Journal, "It will pass. It’s just a matter of when…. Its time is coming."

Jewish Prescription For Health Care Ills

Is our national health care system beyond cure? Rabbi David
Saperstein, director of the Religious Action Center of Reform Judaism, and Dr.
Alexandra M. Levine, medical director of the USC/Norris Comprehensive Cancer
Center and Hospital, believe that the Jewish community can take a role in
advancing remedies for our nation’s health care ills.

The two will share their perspectives during Caring for Our
Nation: Jews and America’s Health Care Crisis presentation on Sunday, Jan. 19,
sponsored by Hebrew Union College-Jewish Institute of Religion’s Kalsman
Institute on Judaism and Health and USC’s Casden Institute for the Study of the
Jewish Role in American Life.

Saperstein, who represents the national Reform Jewish
movement to Congress and the Bush administration, was elected as the first
chair of the U.S. Commission on International Religious Freedom that was
created by Congress. An attorney and the co-author of “Jewish Dimensions of
Social Justice: Tough Moral Choices of Our Time” (UAHC, 1999), Saperstein spoke
with The Journal about health care challenges facing our country and the Jewish
response to this issue.

Jewish Journal: How is health care a Jewish issue?

David Saperstein: Jewish values mandate that every society
has a decent health care system and that access to health care is a fundamental
right of all people. This is also a Jewish issue to the extent that a
disproportionate number of people involved in health care provision are Jewish.

Additionally, it has an impact because the Jewish community
has the oldest median age of any community in America. This impacts Jewish
social service agencies that are funded by our federations and private
charities that administer to the needs of our community. Issues like Medicare
reform, prescription drugs, long-term disability, Alzheimers — these are all
problems that disproportionately affect the Jewish community.

I would add that there are issues of concern relating to
bioethics, genetic research and cloning. [The Reform Action Committee is]
playing a very active role working on legislation that will prevent genetic
discrimination and insure privacy of genetic information. This issue is
especially important for the Jewish community, given that we display specific
genetic tendencies.

JJ: How would you characterize the nation’s health crisis?

DS: We are the wealthiest nation in the world, with the best
doctors, best hospitals and best medical care for those who can afford it. Yet
of all the developed countries in the world, we have the highest number of
people who are uninsured and the highest per capita cost for providing medical

This has created a crisis that affects nearly every aspect
of our society. Our country has an enormous stake in trying to significantly
improve the health care system.

JJ: With such challenges as spiraling health care costs,
nursing shortages, growing numbers of uninsured and aging baby boomers, how do
we begin to address this seemingly vast and complex issue?

DS: There are two different approaches. One is to create a
universal health care system, either along the lines of a single-payer system
or a mix of different kinds of funding approaches akin to the Clinton proposal.

The  second is to do it incrementally, which would likely
begin by building on successful parts of Medicare, Medicaid and SCHIP [State
Children’s Health Insurance Program], which provides coverage for 3.5 million
children who otherwise would have slipped through the cracks….

Whether an incremental or universal approach is taken, the
most important thing is to begin to take steps to address the problem, rather
than continuing to turn a blind eye toward it.

JJ: Here in Los Angeles, the county faces an estimated $700
million deficit. We are seeing closures of county clinics, emergency rooms and
hospitals and an uninsured rate of 31 percent. How does Los Angeles stand in
relation to the rest of the nation?

DS: The problems of Los Angeles are a microcosm of the
problems nationwide. While the national uninsured rate is lower than that in
Los Angeles, it is still unconscionably high. There are currently 41 million
uninsured in the United States.

The hospital and ER [emergency room] closures are due to a
number of factors. First, you can’t provide basic health care for the uninsured
in emergency rooms without significantly straining and overwhelming the
capacity of hospitals to function…. So addressing primary health care and
providing basic health care to the uninsured outside the hospital structure
remains a central challenge.

In addition, we need a coordinated program between the
federal government and the state government to begin to put resources into
inner-city hospitals. Finally, we need to deal with the macro issues. Because
if the entire system is strained, the most vulnerable components — such as
urban centers — will feel it first and most extensively.

JJ: What can we as individuals and as Jews be doing to
improve the situation?

DS: Our synagogues can strengthen their bikur cholim
[visiting the sick] programs to support the people in our communities who are

And while we’re strengthening the volunteer segment of our
work, we need to be dealing with policy issues. The Jewish community has a long
history of playing the lead role in coalitions that have helped transform
America into a fairer, more compassionate society….

The Jewish community needs to be at the forefront of efforts
to develop sensible health care reform that can address these challenges. I’m
hopeful this conference will generate some consensus regarding things that our
community can do to play a lead role in moving the process of reform along.

The free program will be held Jan. 19 from 3-5 p.m. at Stephen S. Wise Temple, 15500 Stephen S. Wise Drive, Los Angeles.  For more
information,  call (213) 740-3405.