Proposition 186: Universal health care battle wages on
By Charlie Chang
The battle for universal health care has moved from the national
level to our state in the form of Proposition 186, an initiative
modeled on Canada’s single-payer system. While no one is against
providing medical treatment for the sick, Proposition 186 is not
the answer.
The initiative fundamentally places unprecedented power in the
hands of an elected commissioner, who could be an everyday
politician instead of a person who actually works in the health
field. This person, who would be allowed to set health provider
rates, nurse staffing ratio and the distribution of medical
technology in the state, has the power of a small tyrant.
The commissioner would also have other broad powers to plan and
regulate our health care services, all under a budget. And we’ve
seen what has happened in Canada’s single-payer system under a
budget. Their system is limited in equipment and treatment,
creating waiting lists that are sometimes one year long. Canada has
one-eighth the number of MRIs per capita than the United
States.
Also, we know the government’s reputation for solving problems.
They do it slowly. The Canadians still haven’t solved their
long-line problems. A competitive system would be much more
responsive to consumers.
Under Proposition 186, there would also be a collection of 2.5
percent surtax on salaries up to $250,000 for individuals and
$500,000 for families. Any income above these levels would have a 5
percent increase in income tax. Corporations would have to pay from
4.4 percent to 8.9 percent in payroll taxes. A $1 tax on cigarettes
would also be implemented.
More taxes are acceptable if they get the job done, but some
estimates say that despite $40 billion in new income and payroll
taxes, the initiative still falls short of expenditures by $14.5
billion. To reduce payroll tax rates, larger firms will most likely
downsize or relocate out of the state.
Spectrum Economics estimates that there will be negative short-
and long-term job losses from the proposal. Short-term effects due
to the wage tax could include a loss of 20,000 to 40,000
insurance-related jobs. Over the long term, by 1998, 300,000 jobs
could be lost in California because of fewer purchases, since the
bulk of the wage tax is absorbed by lower wages.
Under the current health care system, furthermore, doctors and
patients are careful to take only necessary tests and procedures.
This may not be the case with the fee-for-service reimbursements
and minimal cost-sharing in the single-payer system proposed by
Proposition 186. Canada has controlled massive increases in the
utilization of health care only by decreasing provider fees and
rationing high-technology treatments. That’s bad news for the
patients and doctors.
Obtaining health care for everyone should be our moral duty. I
plan to be a doctor in the future, and I don’t want to turn anyone
in need away. But the path Proposition 186 wants to take will stunt
our medical and economical sector and keep us from growing. We
should trust our medical providers to continue their difficult job
of finding more effective and inexpensive ways of treating
patients. We don’t need a "commissioner" to tell doctors how to
treat people. Please vote no on Proposition 186.
Chang is a junior biochemistry student.