SACRAMENTO, Calif. — Despite a legislature in adjournment, a leading California Assembly Democrat passionately criticized the American healthcare system in a special informational hearing Oct. 23.
A select committee was convened in response to the tabling of California's single-payer healthcare bill, SB 562, by Assembly Speaker Anthony Rendon last July. Joaquin Arambula, the co-chair of the committee, is an emergency room physician and spoke from his own experience.
He told the crowded Capitol hearing room that the system is a "medical apartheid for those who can, and those who cannot, afford healthcare resources." Arambula, who represents Assembly District 31 in the middle of the great Central Valley of California near Fresno, said he's seen lives shortened for what he blamed as "a broken immigration system," because undocumented persons are not permitted to participate in subsidized insurance plans of the federal Patient Protection and Affordable Care Act (aka Obamacare).
Near tears, he revealed the tragic story of a 20-year-old diabetic woman he treated in the emergency department who could not afford medicine, only to return at age 28 with kidney failure.
Arambula said that current economic analysis blames wage stagnation, but he attributed that condition to income inequality. His diagnosis: The healthcare system is "a tapeworm on our salaries and our industries." He asked the panel of experts from three think tanks how to control healthcare costs.
UC Berkely Labor Center director Ken Jacobs said that the fee-for-service model used today promotes more money to be made per unit of treatment delivered. Jacobs said we should desire "rewards for positive outcomes, not units of treatment."
Deborah Kelch, director of the insurance industry-funded Insure The Uninsured Project, said costs had three components: defining benefits, defining who's covered, and how providers are paid. Kelch defined managed care as a replacement for fee-for-service in her presentation to the lawmakers as "a coverage model with incentives and/or restrictions to use a defined network of affiliated or contracted providers and at least some management of costs and utilization."
"Managed care in California is always evolving in terms of network model, provider payment methods, and degree of emphasis on managing costs and coordinating care," Kelch noted. She equivocated whether management of care meant management of costs, noting that controlling one did not necessarily lead to affecting the other.
The third panel expert was Edwin Park, an attorney and vice president for health policy at the Center for Budget and Policy Priorities (CBPP). Funded mostly by institutional and private foundations, CBPP analyzes the lower half of the U.S. economic population.
Park's comments to the chair about costs pertained to baby boomers, who have shifted from paying into healthcare funds to now drawing from them. When Arambula inquired about potential federal cuts to healthcare, Park said the "magnitude of the cuts are so large" that 14-22 million persons would lose coverage in the U.S. California stands to lose $800 million in cost-sharing reduction funding alone due to President Donald Trump's recent executive order.
As an emergency room doctor, Arambula noted that patient visits increased threefold in a 10-year period of his practice, which he attributed to lack of access to preventive medical resources. Born in Delano, the birthplace of the United Farm Workers Union of Cesar Chavez and the great Table Grape Strike, Arambula practiced medicine in nearby Selma, California, the Raisin Capital of the World.
The physician-legislator lamented the lack of safety nets for gaps in healthcare coverage, which lead to great costs of lost productivity in the workplace, absenteeism, illness, unmet household needs, medical debt and bankruptcies. The expert panel had no numbers for these costs.
