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I’ve been reading about people like Jim Clyburn advocating "pilot projects" to determine if a public option would work. I generally like Rep. Clyburn, but he–like most uninformed Washington-insiders–is falling into the trap of thinking, "if it hasn’t been tried by Washington, it hasn’t been tried." If Rep. Clyburn had paid attention to the details, he’d know that California has tried a form of a public option, and that it is working flawlessly.
California is a big state. Governing 36+ million people requires lots of state employees–from teachers to police officers to social workers and everything in between. California’s state employees are enrolled in something called CalPers. CalPers has its own health insurance system.
The 1.3 million California state employees who are a part of CalPers health insurance system enjoy a health benefit that is akin to the public option now being debated by Congress.
As California’s other health insurance plans–including Kaiser Permante, the largest health insurance provider in California–are seeing double digit increases in premiums, CalPers premiums are being held to close to the rate of inflation. According to the Santa Rosa Press Democrat, CalPers’ size gave it the leverage it needed to reduce costs in difficult negotiations with providers:
“Size matters in health insurance,” Hodges said, noting that CalPERS can spread major claims over a vast pool of subscribers.
CalPERS attributed the small premium boost for 2010 to hardball negotiations with health plan providers, reduced use of health care by members and increased use of generic drugs."
The theory behind a public option is that a broader health insurance pool will have more leverage in negotiations with drug companies and health care providers. CalPers tested this theory with a pool of 1.3 million enrollees, and managed to keep costs in an environment where private, for-profit plans were being forced to pass spiraling costs onto their customers. Simply put, California has tried the public option on health care, and it is a smashing success.
14 Comments
from wikipedia (my bold):
some questions:
1) calpers’ premium costs were controlled this year, but according to wikipedia have been very high recently averaging 14.2% per year (and much higher than fehbp and and “other surveyed employer-sponsored health benefit programs”). however, what matters most wrt cost is not premium costs alone, but total out of pocket costs which included premiums, copays, deductibles, coinsurance, etc. wikipedia says that some copays have been raised. do you have any data on total out of pocket costs to calpers members and how those costs compare to other plans?
2) i don’t understand which of the plans is the public option and which are the private plans. could you please explain how calpers is akin to what is being discussed in congress?
Californians have TWICE approved single payer only to have a governor veto the legislation and there not being enough votes to overcome the veto.
And I suspect the costs are also held down by all the furloughs,lay-offs,part-time hirings, etc.
And a State that had the world’s seventh largest economy also has this: “In 2007 California had the 2nd lowest number of full-time equivalent state
government employees relative to population among all states. (LINK IS A PDF) California had 103 state employees for every 10,000 residents while Illinois had the lowest ratio at 97. The U.S. average was 143 state employees per 10,000 residents.
California’s ratio of state government employees relative to population was 28%
below the national average.”
You must be talking about a different California. Nothing works flawlessly there not even the public employees. In fact they seldom work at all. I used to live there.
Im not pilling on Ca. but ca program for state employees dosent resemble the PO as most envision it. can the california program be expanded to include anyone? Just opening up medicare would have been the easiest, cheapest and best PO. its there, it works, people like it. The conflict is this; they talked up health care reform, and pretended that it was going to be reform, when what they are working on is a massive bailout for the insurance industry. I dont think Obama was ever interested in health care. Its priority number one for me, so I remember when the Obama campaign came under critisism for not having a plan, they literally copied and pasted parts of various existing proposals (including the clinton proposal, remember when Hil made the “change your xerox” remark?) and had it up on the website a day or two later.As far as O is concerned this is an unfortunate sisdeshow, preventing him from making soaring speeches and attending world summitts and signing ceremonies. Its terribly unfortunate for us as well as him because he wont get there now.
And a State that had the world’s seventh largest economy also has this: “In 2007 California had the 2nd lowest number of full-time equivalent state
government employees relative to population among all states. (LINK IS A PDF) California had 103 state employees for every 10,000 residents while Illinois had the lowest ratio at 97. The U.S. average was 143 state employees per 10,000 residents.
i didn’t know about that, and furthermore, it never even crossed my mind to ask about it. thanks for bringing it up, it’s an important point.
Don’t forget Healthy San Francisco, which even with the limitations put on it by the health industry lobby is still wildly popular (to the figure of 94%) with San Franciscans.
And this is just one city, which though it’s a large one doesn’t have the purchasing power of a large state, much less large nation.
bagofhealth writes:
I like the “akin to” qualifier. The devil’s in the details, though.
Healthy San Francisco may be wildly popular, but polls are a poor guide to available medical care.
Healthy SF has certainly expanded access to primary care for the uninsured, and in that sense it has succeded.
Beyond the expanded access, Healthy SF more resembles a Potemkin Clinic: it expanded access, without any commensurate expansion in capacity. Primary care resources have slightly expanded – access to secondary / tertiary care covered by HSF has, if anything, contracted.
SF’s ambitious Boy Mayor Gavin, his Dem party cheerleaders here, and Dem party fan cubs across the US may love to hold up HSF as a stunning success. Thoug improved access to primary care is better than no access at all, greatly expanding access without even modestly expanding capacity falls far short of a clinically viable solution.
Still, it’s better than nothing…
Here is my take on CalPers and comparisons to other health plan costs. This is from memory but I think it is approximately OK.
The CalPers covers state and local employees, not just state employees.
It is true that the ratio of CA state employees to state residents is much lower than the average. the ratio of regional agency and local government is much higher. In fact for some work categories, the ratio of CA state employees is much lower, only 10% to 25% of average, and the local employees much higher. CA seems to have adopted a model where more tasks are done by lower levels of government.
On average the ratio of state, regional and local government employees to residents in CA is about average, as is the ratio of annual total employee compensation to state GDP.
(you can check all this stuff from census data in the US Statisical Abstract)
I think only 25 to 30 per cent of CalPers enrollees are state employees as opposed to other government.
So, the enrollment is probably representative of total government work force in average state.
CalPers offers several options, including enrollment in some BC/BS plans and Kaiser. So some one would have to separate out the CalPers plans costs from the others for a direct comparison to private plans for under 65.
CalPers also has insurance programs for retirees, and long term and nursing home care, which are not part of typical private plans. Again, you would also have to adjust for that in order for a direct comparison to private plans.
As for poor deluded (or envious and resentful) people hating on CA, smile like you are joking when you say that, and I will meet you out behind the backstop after school anyway.
Cali working flawlesly? is that prior to them trying to sell everything just to cover all the state workers?
I don’t think CalPers has a public option. It’s more like what you would get with an exchange of private insurers if the feds had the guts to use their bargaining power to force rates down. The closer thing to a public option is the Healthy San Francisco (or something like that) project. We really need some help in California this next election. We have so many good ideas and yet so many crazy people and ideas to make sure it only works in spurts. No progressive or even moderate who has half a brain registered in CA is allowed to sit this one out, okay?!
California is an example of why we CAN’T follow their health plan. They are a prime example of why socialism DOES NOT work! Look at their debt. It is there because they have taxed the workers to death to give and give. They are also an example of what happens when you allow all these illegals to enter the country and freeload of us. Most of us work hard for our money and do well to take care of ourselves and our families. We should be able to choose who we want to help when our resources permit it. The government that rules the least, rules the best. Let’s get back to that. Vote all our politicians out and get a new slate!
…greatly expanding access without even modestly expanding capacity falls far short of a clinically viable solution.
true. but i’ve read that san francisco has, by far, the highest concentration of doctors in the country, with something like twice the national average, which suggests that the capacity is there.
San Francisco is a large city by no measure. It has just over 800,000 residents and 49 square miles (land). And Health SF is a permit to get a clinic appointment in 6-8 weeks for non-urgent (but necessary for troubling symptoms) care.