Health Care

By Patty Berg

"The health care system in California is on the brink of collapse, demanding government intervention. It has become painfully clear we can no longer continue to do business as usual. We must evaluate new models of health care delivery for our state and our rural counties. Our goal must be universal health care. No one should be left out." -- Patty Berg

· Uninsured/Underinsured

Nationally 45 million people have no health insurance, and at least 39 million are underinsured. In California, over 7 million people have no health insurance1.8 million of those are children. The majority of those persons who are uninsured work full time in jobs that either do not provide health insurance or do not pay well enough to afford private insurance. They most often work in wholesale, retail, construction and agriculture.

· Health Care Costs/Access to Health Care

The cost of health insurance is the main reason people do not buy it # even if their employer offers it. The cost of health care and health care insurance continues to escalate. Costs are expected to jump once again # to 16 percent this year.

Sixty-five million Americans have no drug coverage, and the cost of prescription drugs increased by 18.8% from 1999-2000.

Medi-Cal is the state-federal health care program for more than 5 million low-income Californians administered by the Department of Health Services (DHS). A major problem with Medi-Cal is that rates paid to physicians are relatively low compared to the rates paid by the federal Medicare Program. Why? Because DHS has failed to conduct annual rate reviews or make periodic adjustments to Medi-Cal rates to ensure reasonable access to health care services for low-income people. There should be a rational basis for setting and adjusting Medi-Cal rates on an annual basis. Inadequate reimbursements to physicians means fewer physicians participate in the program, which negatively impacts access to care for Medi-Cal patients.

· HMO's Failure to Provide Services in Rural California

HMOs are mainly concerned with numbers to derive profit. In rural areas there are not enough residents to make it profitable. It is also believed that rural people tend to have more health problems, are often older, and sometimes poorer. As of the first of the year, 16 rural counties in California have lost some or all of their HMOs. Blue Shield, Health Net and PacifiCare have have stopped serving patients in much of the 1st AD, leaving over 12,000 residents without coverage in Humboldt, Trinity, Lake and Mendocino counties. Of course, what happens is that people are faced with switching insurers, paying higher premiums and out-of-pocket costs, or traveling outside the area for care. In the arena of managed care, physician-patient relationships are threatened for fear of retaliation from HMO administrators, concerned with profits.

· Medical Practitioner Shortage in Rural California

"Record numbers of individual physicians are quitting practice, retiring early, leaving the state or changing to non-clinical jobs," stated Jack Lewin, Chief of the California Medical Association. A survey conducted by the CMA this year, found 30-50% of California's private physicians will leave practice in the next five years mainly due to: inadequate reimbursement levels; a government regulatory environment that negatively impacts the quality and availability of patient care and managed care. These findings proved true in the 1st AD. Rural areas in California have a shortage or lack certain physician specialties; we have difficulty recruiting and retaining dentists in our communities and we continue to experience a nursing shortage of major proportion.

· Hospital Issues

Hospitals in the district are faced with financial problems caused by empty beds, under use of costly equipment, and reimbursements that are too low (15 cents on the dollar for Medi-Cal patients). Hospitals are also struggling to keep open emergency rooms (which those without health insurance often use as their primary care provider) and, are facing the daunting financial obligations to retrofit hospital buildings. In the last year, California has closed 20 emergency rooms, further jeopardizing access to care for the uninsured. The cost of providing care in a hospital emergency room is several times that of a doctor's office.

· Mental Health and Public Health Services Grossly Under funded

Over 30 years ago, California decided that people with mental illness should live in their communities rather than be locked up in institutions. It was determined they would benefit from community-based treatment. We have failed to follow through with all that was required by this decision. As a result, people with serious mental illnesses live on street corners and sleep in parks. They are in our jails and prisons # jailed for their protection, not the public's. They are disproportionately represented among the poor, the victims of crime, the unemployed and the homeless. Mental health programs are the chronic losers in budget debates, and an estimated 1.5 million Californians are in need of help, but do not receive it. We simply have to dedicate more resources to mental health.

For the sake of everyone's health, we must make adequate investments in California's public health system and guard against shortsighted efforts to balance the budget at the expense of Californians' health and well being. Some have suggested borrowing against future tobacco settlement funds in order to plug the hole in the current year's budget. This would be a mistake. It is in the long-term interest of our people to ensure that these funds are preserved for legitimate public health purposes, such as expanding health coverage for children, treating breast and prostate cancer, and tobacco prevention.

Patty Berg's Health Care Agenda

· Research and refine "new models" of health care delivery tailored to the health care needs of all Californians # the goal being to ensure all Californians have access to affordable and dependable health services. · Ensure all qualified children and working families are enrolled in the Healthy Families Program and learn from Santa Clara County's successful outreach model. · Provide prescription drug coverage to low-income senior citizens using the Illinois SenioRx Program as a model. · Make available affordable and comprehensive long-term care insurance that guarantees a menu of services, including: home care, assisted living and convalescent care. · Establish a rational process for annually reviewing and adjusting Medi-Cal rates, using the Medicare rate-setting system as the benchmark. · Require HMO's who do business in California to provide services in rural areas. · Provide incentives to medical practitioners (such as offsetting school loans) who practice in rural, underserved areas. · Invest in comprehensive services for the mentally ill, including community-based resources. · Ensure tobacco settlement revenues are reserved to achieve legitimate public health objectives, like expanding health coverage for children, breast and prostate cancer treatment, and tobacco prevention.