California’s largest health care system is a single-payer system (“Medi-Cal”) that covers the state’s 13 million poorest residents, a population greater than all but four states. Service is terrible. Despite spending of $100 billion per year, appointments are hard to get, emergency room visits are up, there’s little indication of greater healthiness, and there’s even evidence than uninsured patients do better than Medi-Cal insured patients in some cases. Yet the California Legislature has not seriously tried to fix it.
Indeed, in a twist worthy of George Orwell, a Select Committee in the legislature recently proposed reforms to other parts of the health care system but, with a single exception, not to Medi-Cal! Meanwhile, excessive Medi-Cal spending is also crowding out funding for the needy, courts, parks, the University of California and California State University.
It’s not as is there aren’t plenty of reforms for the legislature to consider and adopt. To boost customer convenience the legislature could change scope of practice laws and establish co-locations at fire stations and schools. To reduce visits to expensive hospitals the legislature could adopt a “cap-and-trade” type approach that employs sticks-and-carrots to encourage customer treatment at lower cost locations. To reduce super-use of expensive hospitals and to improve lives for patients with chronic conditions the legislature could utilize less expensive social programs to reach cost-emergent users in advance.
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