5 Things CA: US Senate, single payer, Micah Weinberg

I was reminded of Churchill while watching the vote in the US Senate. This is a quote of his about which many might agree:  “Now, this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

The US Senate and a few other notes are what we’re watching this month in California health care.

DJ 5 Things Signature





1.  The motion to proceed in Senate

The vote yesterday in the Senate on the motion to proceed to debate was dramatic. Sen. Ron Johnson (R-WI) held out his vote until the last minute. He was followed by comments from Sen. John McCain who stated that the lack of bi-partisanship is hurting the Senate and hurting America.

The Senate now has 3 days of debate. It appears likely that the Senate will fail to get to 50 votes for any single proposal, though things are still fluid. They plan to vote by the end of the week, but there is a long road ahead before final passage.

Notably, Gary Cohen from Blue Shield of California was testifying before House Democrats at the same time the Senate was voting. “The reason why health care is expensive in America is because of the unit-cost of health care. That’s the reason. We need to start thinking about how we’re going to grapple with that, and the more time we spend on fighting over these issues that are consuming our time today, the harder it’s going to be to get to that discussion.”

2.  Changes at Western Health Advantage

Western Health Advantage had a bit of a shake up this month when founder and co-owner UC Davis withdrew from the primary care network over a disagreement over reimbursement rates. Now 23,000 of WHA’s members will either need to find a new provider or a new health plan.

Members have a few more options though with WHA’s new partnerships with UCSF medical system and John Muir Health, bringing more than 4,000 physicians, 13 hospitals, and a dozen urgent-care centers into the network. WHA also recently opened membership to the California Public Employees Retirement System.

3.  Fractious single payer coalition in Sacramento

Secret amendments, “brass-knuckle leadership,” and a tabled bill. Surprisingly, I’m not talking about any of the federal reform efforts, but California’s single-payer bill and a key supporter, the California Nurses Association.

In this recent article in The Intercept, David Dayen presents the Campaign for a Healthy California as a fracturing coalition following Assembly Speaker Anthony Rendon’s decision to shelf the bill. Other coalition leaders say the CNA is unwilling to collaborate and didn’t address the bill’s shortcomings, most notably a lack of a financial plan. One coalition member calls the movement “a weapon in intraparty politics” as the CNA targets would-be allies. It’s likely the bill will resurface during the next legislative session so a fractured base weakens its chance of passing, even with a detailed implementation plan.

4.  Video: Micah Weinberg, PhD

Micah Weinberg, PhD is the President of the Economic Institute, Bay Area Council where his team produces economic and policy analysis and insight. He has a degree in politics from Princeton University and a doctorate in Political Science from UNC Chapel Hill.

So, it only makes sense that when he sat down with us in this edition of “What They’re Watching” he talked about politics and policy in health care. “The politics and policy have almost nothing to do with each other. You know, these occur on pretty much completely different tracks. And people forget that in the political process.”

5.  New CHA CEO and learning from Maryland

Carmela Coyle has been selected as the new President and CEO of the California Hospital Association and the California Association of Hospitals and Health Systems. Coyle previously was Maryland Hospital Association’s President and CEO where she moved the hospital payment system to a value-based methodology. She replaces Duane Dauner, who is retiring.

A lesson from the Maryland hospital experience is that predictability is key, and that hospitals can keep patients out of their facilities with the right incentives. Martin O’Malley spent time with us recently detailing the model he implemented while Governor of Maryland.

California hospitals have not always been centers of innovation on cost in recent years.  One reason: “health care executives are not paid to slow spending,” according to this study.