OP-ED: DR. ARTHUR CHEN
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The benefits of UF would address for each group: Employers: Through the elimination of the employer health benefit procurement role, administrative burden would be reduced, thus enabling a focus on business goals rather than employee health coverage needs. Individuals: Through universal coverage, more equitable financing, and delivery system changes, health care quality, accessibility, and equity would improve. Health Care Providers: A single set of rules for payment, quality, and other outcomes would simplify the reimbursement process.
WHAT ABOUT COSTS AND SUSTAINABILITY? The Commission found that absent a shift to UF, aggregate health care spending in the state is estimated to increase by $158B, or approximately 30%, in 2022 dollars over nine years. Under almost all the scenarios analyzed, in the first year of implementation, UF is expected to result in lower total health care expenditures than under the status quo – and for single-payer public UF, $9 to $35 billion in savings would be realized, depending on income-related cost-sharing and long-term care coverage and with health plan intermediaries. Significant savings from UF would accrue to the vast majority of California employers and households, which will on average pay less to support UF than they pay in the status quo. Financing can be stable over time but will depend on controlling cost growth and securing agreements with the federal government on the rate of growth in federal payments. WHAT ABOUT PROVIDER PAYMENT? The Commission did not dictate any specific formulas or processes. They acknowledged the benefits of hospital global budgeting based on the Maryland Total Cost of Care model. They called for physician payment negotiations for fee-for-service and acknowledged capitation and salaries as options, along with necessary incentives for quality, health equity, addressing complex patients and social drivers of health, and increasing physician supply in underserved areas. WHAT ABOUT HEALTH EQUITY? COVID revealed an even uglier side of structural racism, which has disproportionately impacted communities of color for decades preceding the pandemic. In seeking community input from marginalized communities through interviews and surveys, HCFA found strong support for a single, statewide, government-run health care program that covers all people who live in California. Their poll suggests that 65 percent of Californians with
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low incomes support the concept, with people of color showing greater support: 76 percent of African Americans, 71 percent of Latinos, 73 percent of Asian/Pacific Islanders, 65 percent of Native Americans, and 54 percent of whites. They also found that Californians with low incomes would value three key attributes of a reimagined healthcare system, including cost and affordability, access to care, and cultural humility and respect. In summary, the HCFA Commission report signals Unified Financing as a bold step toward achieving universal coverage that is affordable, high quality, and cost conscious while advancing health equity. They found the single-payer version of UF would yield the most savings. They estimated that universal coverage would save 4,000 or more California lives annually. On a national scale, a recent Yale study projected that as of mid-March 2022, universal health care could have saved more than 338,000 lives from COVID-19 alone, and that the U.S. could also have saved $105.6 billion in health care costs associated with hospitalizations from the disease – on top of the estimated $438 billion that could be saved in a non-pandemic year.2 Close to home, the SF Latino Task Force and the SF Latino Parity and Equity Coalition, which serves 20 nonprofits crucial to San Francisco’s COVID response and focuses on Black and Latino residents disproportionately impacted by COVID, faces a $9.5 million cut in proposed funding. The mayor’s office said that COVID services were funded by temporary, one-time payments from the state and federal governments that “no longer exist.” Isn’t it about time we physicians took a bolder step towards universal coverage that is transformational and true to our patients’ and community’s interests – especially our low-income and marginalized communities? No system will be perfect and every system will require our ongoing advocacy and wise counsel in seeking continual improvement. This is our opportunity to accelerate toward true universal coverage, to avoid the ongoing pain and suffering wrought by our current system and structures that rations care based on the ability to pay and the color of one’s skin. As California goes, so goes the nation. Let’s lead! Arthur Chen, MD is a Senior Fellow in Family Medicine at Asian Health Services in Oakland and a past president of the ACCMA. Steve Tarzynski, MD, MPH is a retired SCPMG pediatrician and President of the California Physicians Alliance (CaPA). NOTES 1 Jessica Altman et al. (2022) Key Design Considerations for a Unified Health Care Financing System in California, delivered to Members of the Healthy California for All Commission, April. bit.ly/3afxwRe 2 Rachel Nuwer (2022) Universal Health Care Could Have Saved More Than 330,000 U.S. Lives During COVID, Scientific American, published online June 13.
ACCMA BULLETIN | JULY/AUGUST 2022
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