Is it the Arnold Ostrich Administration?
Gov. Arnold Schwarzenegger’s administration has sometimes been called corrupt, as when he was accepting millions in fees from body-building magazines while serving as governor, and even now as his top staffers are paid more from his special-interest-financed political committees than from their state salaries.It has been called a Teflon administration, as when he promised to hire a private detective to investigate his own admitted past sexual misbehavior, but never did and there were no consequences.But on at least two of the hot issues Schwarzenegger himself has pronounced most urgent for both California and the nation, it might be better to call his the Ostrich Administration. For he’s clearly got his head deep in sand, or something, when it comes to both greenhouse gases and universal health care. On greenhouse gases, the final budget Schwarzenegger sent legislators this year would have cut out Williamson Act subsidies to farmers, a program that keeps more than 16 million acres of farmland from being developed. That farmland removes at least 1.75 million tons of carbon dioxide from the air each year, far more than any other state program now existing or envisioned.Legislators eventually put it back in the budget and Schwarzenegger later left it there, lamely claiming that I’m glad they put it back in. Like an ostrich with hidden head, he had not looked at what his proposed cut would mean to his own cherished ideal, one which he has advocated before countless world leaders.Just as egregious is his failure to examine the details of his plan to impose universal health care coverage in California, forcing even those who don’t want insurance to buy it.Problems here include those two key D-words: deductibles and doctors. Schwarzenegger and his aides have virtually ignored the problem of high deductibles, which could make health care premiums a worthless expense for the working poor, if they or their families don’t have major health problems in any one year.That difficulty, however, could likely be dealt with by raising premiums paid by the wealthy to make up for costs of lower deductibles for those buying the most rudimentary catastrophic coverage.But the doctor problem won’t be so easy. Schwarzenegger proposes to add a minimum of 900,000 patients to the state’s Medi-Cal rolls, paying for this in part with additional available federal matching funds and with a tax on hospitals that now treat the uninsured in emergency rooms, often without getting paid for their services. The hospitals are willing to go along with this because they figure a guarantee of payment will more than make up for any tax they’d pay.But who would treat those patients? Currently, only 35,000 of the state’s almost 65,000 practicing physicians accept Medi-Cal patients, and for most of them the indigent on the program make up just a small part of their practices.Add 900,000 patients to Medi-Cal’s enrollment and you’d need a minimum of 650 doctors to treat them, assuming each doctor has a practice of 1,200 patients and all are Medi-Cal recipients. The average California doctor’s practice includes about that many persons, but almost none is exclusively Medi-Cal.There is, of course, a reason barely half of all the state’s doctors take Medi-Cal and why most of those who do see its members don’t see many of them: Payments from Medi-Cal are so low doctors can’t afford to pay for office rent, insurance, staff and supplies if they see mostly Medi-Cal patients. In a salient commentary published this fall, Fresno County surgeon Linda Halderman noted that breast cancer specialists receive $24 for a patient consultation no matter how long they spend with a patient, while a two-hour breast-preserving cancer operation and the 90 days of after care that goes with it bring the doctor only $253. Any other medical plan would pay almost double those amounts and physicians who refuse to accept any HMO patients charge far more than that. Those payment levels won’t cover much of any doctor’s expenses. Yet, Medi-Cal is slated for a 10 percent cut in payments next year. Halderman said she treated such Medi-Cal breast cancer patients at a loss for four years before she stopped taking them this fall.Many doctors don’t stick it out that long. And unless Medi-Cal payments rise considerably under the new program, it will be impossible to find the equivalent of 650 more doctors willing to accept an entirely Medi-Cal population for their practices.But Schwarzenegger doesn’t discuss these dismal facts as he travels the state plumping for his program. Maybe he just hasn’t bothered to look into the details of what he’s doing, just as he didn’t bother checking on the consequences of his attempt to eliminate the Williamson Act. Whatever the reason, it’s plain he’s acting like an ostrich and depending on his old-reliable Teflon to keep from suffering any consequences for why is plain old intellectual negligence.Thomas Elias writes on California issues. His email address is firstname.lastname@example.org.
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