Changing the narrative about “single payer” healthcare

  • Sibert, Karen, MD, FASA
| Mar 19, 2018

Sibert_resizeIt’s time to divert the political narrative in Sacramento from universal health coverage, or “single payer” insurance – to be guaranteed by state government at whatever cost – to universal access to healthcare. The California Medical Association (CMA) on Thursday announced that it is throwing support behind a legislative package designed to improve access to care without emptying the state’s coffers.

The California Senate bill proposing single-payer healthcare, SB 562, received wide publicity this year though it hasn’t got a chance of being signed into law. The LA Times editorial board acknowledged the many unresolved issues in what it called the “fast-moving but half-baked Senate bill.” SB 562’s $330 to 400 billion estimated cost would be more than California’s entire annual budget and could “make California a magnet for anyone who needed expensive healthcare.”

CSA and CMA are part of a broad coalition of healthcare professionals – including physicians from many specialties, nurse practitioners, nurses, dentists, and pharmacists – that opposes the bill. The California Nurses Association, which isn’t the only union representing California nurses, is the bill's primary champion among a small core of health-related advocates.  

However, there’s no argument about the fact that millions of Californians still lack access to basic healthcare. CSA supports in principle key components of the package that would increase patient access to physician services. These include:

  • Increasing funds for physician student loan repayment so that physicians can afford to stay in California;
  • Increasing funds for residency positions, especially in primary care;
  • Strengthening state laws regarding oversight of mergers of health insurance corporations;
  • Increasing MediCal payment rates to increase access to care for the nearly 14 million Californians currently covered by MediCal;
  • Simplifying the administrative processes for insurance authorization, quality measure reporting, and other burdensome regulatory requirements.

It remains to be seen what the final cost of this legislative package would be, and whether it would require new taxes. We will be tracking the issue closely.

Representing CSA at CMA

The CMA held two key meetings last week in Sacramento. On Thursday, the Specialty Societies Meeting was chaired by Michele Raney, MD, a physician anesthesiologist and longtime CSA member. I attended, along with Dave Butler, our Executive Director, and our lobbyist Vanessa Cajina. We heard updates from CMA officers about upcoming legislation related to healthcare, and Mr. Butler and I gave a well-received presentation about our community outreach with Project Lead the Way.

Much of the discussion at the CMA’s day-long Council on Legislation meeting on Friday centered around the opioid epidemic. The legislature hasn’t been slow to jump on this hot-button topic, with nearly 20 new bills attempting to mitigate the problem. However, CSA is united with CMA in the belief that the legislature should not be in the business of practicing medicine.

Bills that intend to control prescription duration, mandate CME, increase burdensome reporting requirements, or otherwise restrict our ability to treat our patients’ pain appropriately, are non-starters, and we will continue to oppose them as CMA and CSA have done all along.

On behalf of CSA members, I offered testimony on the continuing opioid shortage which is having a significant adverse impact on hospital anesthesiology practice. CSA’s Chair of the Committee on Pain Medicine, Shalini Shah, MD, is quoted in a major article on this topic, published last weekend in the LA Times and other national publications.

We will continue to support the development of a robust and secure CURES database, which will protect physicians in every discipline by enabling them to check on a patient’s prescription history quickly and reliably, and reduce indiscriminate “doctor-shopping” for narcotic prescriptions. Further, we support CMA’s stance that the CURES database should reside within the state healthcare administration rather than with the Department of Justice, and we hope this change can take place as soon as possible.

Representing anesthesiology’s interests at these meetings, in addition to Dr. Raney and me, were:

  • Jeff Poage, MD, our Chair of the Legislative and Practice Affairs Division;
  • Harrison Chow, MD, who represents us in the CMA’s Hospital-Based Practice Forum;
  • Chul-Kyun Park, MD, one of CSA’s alternate delegates to CMA;
  • Paul Yost, MD, past president of CSA and now President-elect of the Orange County Medical Association;
  • Lee Snook, MD, Speaker of the CMA House of Delegates.

We can’t emphasize enough that the House of Medicine is stronger when we speak with a united voice! If you’re not already a member of CMA and your county medical association, please join today so we can deliver a powerful message to our legislators on all these important issues.





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