The New Health Dialogue

Source: California Office of the Governor

The newswires and blogs are abuzz over whether California's Governor Schwarzenegger will sign legislation that would create the "California Health Benefit Exchange," a key piece of federal health care reform.  I weighed in on the San Jose Mercury's opinion page to point out that the exchange could have a major impact in the state:

The exchange will be a new state agency that will set up two health insurance purchasing pools, one for individuals and one for small businesses. Only people taking advantage of subsidies or tax credits will be required to purchase through these marketplaces. To be successful, though, the exchange will have to compete for and win a significant chunk of the business of people buying health insurance without financial assistance, particularly in the small-business market.

It could make a real difference for Californians, but only if it offers high-quality, low-cost health insurance products that appeal to us. It will do this by negotiating with insurance companies for better rates and working with these insurers to promote more effective, less costly medical care. This is no different from what big corporations and public employee groups like CalPERS [California Public Employees' Retirement System] do. Many of these businesses and some insurers are excited to have a new partner in these efforts.

California Healthline in its piece on the politics and policy surrounding the state exchange included my views:

"It's not so much insurers on one side and patients on the other, it's not like that," Weinberg said. "This is more or less the progressive and less-progressive elements of these different health communities." He said that if the governor does veto the exchange bills this week, it will send everyone back to the drawing board, likely in a more politically charged, less results-oriented environment.

The process in California this year that resulted in the exchange legislation was, in many ways, a policy wonk's dream.  The legislation was shaped by the expertise both of representatives of the Democratic state Legislature and the Republican administration as well as by outside consultants such as Jon Kinsgdale who ran the insurance connector in Massachusetts and Rick Curtis and Ed Neuschler who worked extensively with California stakeholders during our own push for healthcare reform in 2007.  The people at the Pacific Business Group on Health who ran a major small business health insurance exchange also weighed in with their experience as did representatives of small businesses, in particular Small Business Majority and Small Business California. Insurers also had a significant voice in the process.

The technical challenges to building and running and successful exchange are enormous, and there are limits to what can be accomplished by expertise alone. But it is a fair sight better to start from a point in which we honestly address these large challenges to the best of our ability rather than having the Exchange be a political football.  Let's hope we don't have to play that game.