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California health plan conscripts your doctor and your care

June 9, 2017

Mike F. Brown

By MICHAEL F. BROWN

The story in the 1965 dramatic movie epic Dr. Zhivago takes place a little less than 100 years ago during the time of the Bolshevik revolution. It depicts the fated destruction of an upper class Moscow family as the consequences of World War I and the revolution that consumed them.

In true Russian literary style, the story contains tragic love affairs, suffering from war, personal loss, and large-scale social displacement. It is lavishly filmed against the background spectacle of civil war, expropriation of private property, and brutal extermination of “the enemies of the Revolution.”

One scene, which always stood out, describes how Red Partisans conscript Dr. Zhivago at gunpoint to serve as their brigade medical officer. Obviously physicians were not rushing to volunteer. In the film clip to the right, the Red commander states, “Comrade doctor, we are Red Partisans and I need a medical officer.”

When Zhivago pleads that he can’t go because he has a family to care for, the commander menacingly replies, “Comrade medical officer, we shoot deserters.”

Unlike Dr. Zhivago’s captors, California’s current ruling enviro-socialist regime does not contemplate shooting doctors, hospital directors, and other medical providers to force them to “enroll” in the new so-called single payer state takeover of medicine. Instead the Democratic State Legislature’s proposed massive revolutionary expropriation of medicine, as contained in SB 562 “The Healthy California Act,” simply requires that anyone who needs or who might need medical services must enroll.

Simultaneously, it requires that anyone or any organization that provides medical services must enroll as a provider and agree to accept the fees, rules, and regulations established by the state in order to be paid. All persons living in California, including non-citizens will be covered.

Key provisions include:

1. The bill creates a new government agency called Healthy California (HC), which will be governed by a 13 member Healthy California Board of Directors. The governor will appoint four members, the speaker of the Assembly will appoint four members, and the Senate Committee on Rules will appoint four members. The State Secretary of Health and Human Services will serve as an ex-officio voting member.

The members will be appointed by class, including three members of labor organizations representing nurses, three representatives of the general public, three representatives of other labor organizations, and three representatives of the medical “provider” community. The appointment formula insures that, like the infamous and rogue California Coastal Commission which is appointed by the same tripartite formula, the new agency will be uncontrollable and none of the elected appointers can actually be held accountable.

The big difference from the Coastal Commission is that this new agency will control half a trillion dollars annually and virtually every aspect of the medical care system in the state. The obvious structural weighting of labor members will insure that powerful public employee unions will rule the entire medical system.

Imagine the political patronage power that will derive from awarding contracts, filling thousands of jobs necessary to administer the system, employing legal firms, hiring consultants, and all the rest. Moreover the agency will be able force medical providers such as hospitals, physician groups, pharmaceutical suppliers, and other entities over which they will have absolute power, to mirror and support that patronage power.

2. The HC will have the power to negotiate payment rates for medical services for all providers, including doctors, hospitals, not-for-profit health agencies, dentists, vision care providers, nursing homes, long-term care providers and virtually every other type of medical service. This includes single office physicians all the way up to large entities such as Kaiser and everything in between. It will also have the power to regulate the price of pharmaceuticals.

In regard to negotiating provider contracts, the act allows the HC to conduct the negotiations in secret.

“The board shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2), except that the board may hold closed sessions when considering matters related to litigation, personnel, contracting, and rates.”

The Legislature then makes a special finding to make fast this provision:

“The Legislature finds and declares that Section 2 of this act, which adds Sections 100610 and 100617 to the Government Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the “Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:

“In order to protect private, confidential, and proprietary information, it is necessary for that information to remain confidential.”

Adding even more control, the proposed Act regulates who can negotiate rates and other conditions on behalf of providers with the HC:

“(a) Before engaging in collective negotiations with HC on behalf of health care providers, a health care providers’ representative shall file with the board, in the manner prescribed by the board, information identifying the representative, the representative’s plan of operation, and the representative’s procedures to ensure compliance with this chapter.”

This seems to require that providers give away their negotiating position before entering into negotiations with the HC.

More bizarrely, the act requires that the negotiating entities must pay a fee to cover the state’s costs of conducting the negotiations.

“b) Each person who acts as the representative of negotiating parties under this chapter shall pay a fee to the board to act as a representative. The board, by regulation, shall set fees in amounts deemed reasonable and necessary to cover the costs incurred by the board in administering this chapter.”

What would the sponsors of this bill think if such a provision were to be required for state, municipal, and educational unions to bargain collectively with their employers?

3. Providers that are organized as for-profit entities will be required to meet the same requirements and standards as entities organized as not-for profit. In this regard the proposed               Act states:

“Payments to those entities shall not be calculated to accommodate the generation of profit from dividends, or the return on investment or the payment of taxes that would not be paid by not-for-profit entities.”

How will this impact a variety of businesses such as imaging centers, surgical-centers, private hospitals, nursing homes, for-profit dental providers, optometrists, privately owned ambulance companies, and other providers in the state? Is this simply outright confiscation and destruction of private business by the state? Will already high ambulance rates double as the private companies are driven out of business and thus as municipal fire and ambulance departments take over and must cover their unfunded pension liabilities and high labor rates.

Significantly, and what the Legislators seem to have forgotten, is that they do not yet have the power to force doctors to stay in California. Many doctors might choose to retire. Some could band tougher and set up group practices that cater to wealthy patients who don’t use private insurance, Medi-CAL, or Medicare. These so-called concierge practices could balloon. Others could move to Austin, Scottsdale, and the Nevada side of Tahoe, Rocky Mountain states, or even communities on the eastern seaboard. Physician recruitment firms are desperate to find younger well-trained clinically competent doctors who demonstrate great patient presence.

One question is how will the doctors, who are the key to any medical system, react? Are they ready to surrender professional independence to become de facto vassals of the state? Most doctors are smart. They had to get straight A’s in undergraduate school and take calculus, organic chemistry, and heavy doses of biology and anatomy, etc.

This is in contrast to gender studies, global warming studies, or other currently in-vogue politically correct subjects that are passed off by intimidated academic administrators as university-level courses. The rigorous science background is required to be admitted to medical school. Medical school and the subsequent residencies are essentially academic and physical boot camps. All in all, most doctors are in their 30’s before they can charge their first fee and many are broke, owing huge tuition loans.  If the state is going to regulate their fees, how can they stay here?

Being a successful doctor is not a bed of roses. There is constant pressure to see enough patients to pay the overhead for nurses, medical assistants, office expenses, billing systems, and mal practice insurance, and to still afford a home, join a service club, and meet other requisite community expectations. Note, that even if a doctor works for a large organization, such a Kaiser or Samson-Santa Barbara, the underlying economics remain the same. An internist needs to see 16 to 20 patients in an afternoon session (after hospital rounds in the morning) to earn a living.

Every specialty has relentless productivity metrics. Additionally most doctors must work a number of weeknights and weekends on call to cover general hospital care and in many specialties, the ER, ICU, or surgical suite

What if the doctors refuse to embrace giving up professional independence and historic status in the private sector to become heavily regulated high paid government technicians? You can get your medical care in Las Vegas.

Mike Brown is the government affairs director of the Coalition of Labor Agriculture and Business (COLAB) of San Luis Obispo County. He had a 42-year career as a city manager and county executive officer in four states including California. He can be reached at mike@colabslo.org.


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Mr. Brown is supporting the current medical monopoly and drug prices 10-1,000 times that in Canada. He knows that he cannot, as bad as he wants to, deny health care to the indigent so he wants it to be as expensive as possible out of pure spite.


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Why do we, as Californians, continue to elect such out-of-touch individuals to “represent” us. I have watched those elected (Pelosi, Harris, etc) embarrass themselves and us as they try to explain themselves while being interviewed. If the left nuts would spend half as much time addressing what the average tax payer needs (tax relief, affordable and sustainable health service, immigration reform) instead of trying to retain their positions by doing nothing … Something might be accomplished.


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>”California’s current ruling enviro-socialist regime…”


>”like the infamous and rogue California Coastal Commission…


>”This is in contrast to gender studies, global warming studies, or other currently in-vogue politically correct subjects that are passed off by intimidated academic administrators as university-level courses.”


Mr Brown, it’s quite clear that you hate environmentalists with you non-stop efforts to smear them. Don’t you ever get tired of that?


>”2. The HC will have the power to negotiate payment rates for medical services for all providers, including doctors, hospitals, not-for-profit health agencies, dentists, vision care providers, nursing homes, long-term care providers and virtually every other type of medical service. This includes single office physicians all the way up to large entities such as Kaiser and everything in between. It will also have the power to regulate the price of pharmaceuticals.”


And what the heck is wrong with that? Maybe you’re rich so you’re out-of-touch with how much medical costs the average person/family. Lots of people have been bankrupted by their medical bills and I suspect lots of homeless people ended up on the street that way. YES we need oversight of what these people charge, because without it the guys charge every last farthing they can until they’ve bled their patients dry. It’s criminal. What’s funny though is the hypocrisy. You’d cry bloody murder if a penny is added to your taxes. But make health care affordable to the poor and you are up in arms.


>”Many doctors might choose to retire. Some could band tougher and set up group practices that cater to wealthy patients who don’t use private insurance, Medi-CAL, or Medicare. These so-called concierge practices could balloon. Others could move to Austin, Scottsdale, and the Nevada side of Tahoe, Rocky Mountain states, or even communities on the eastern seaboard.”


These are the guys who are already way over charging for their services. But if they feel that they just can’t be fair in their pricing I say let ’em go! Good riddance!


>”All in all, most doctors are in their 30’s before they can charge their first fee and many are broke, owing huge tuition loans.


So that makes it ok to just pass on their freely chosen debt to those in desperate need of health care? Wouldn’t a much better and fairer solution be to legislate how much these colleges, and rip-off insurance companies are charging? And your railing about how cheap private companies are compared to public is entirely backwards. Government run business is always way cheaper than private. That’s because the cost is spread out among millions of people making the amount each pays much less that private companies that have thousands and operate on a charge “what the market will bear” for profit driven system.


http://www.tikkun.org/nextgen/health-care-versus-wealth-care-investors-with-a-conscience-should-divest-from-health-insurance-companies


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Like anything there are 2 sides to every story. There needs to be some type of oversight for the medical field. A year ago I got dehydrated and went to the hospital for 20 hrs. The bill that was initiated was $24,000. Things like that should be unacceptable, and this was a non-profit hospital. Non-profit only means that they pay little or no taxes. How many poor doctors or people in the medical field can you name? Yet on the other hand the oversight that is now in place due to liabilities that the ambulance chasing attorneys have created have just added enormous costs to the medical field. And remember a vast number of politicians are attorney’s.

Then there is the other side of the story. With the government involved and with the current mind set of the fools in Sacramento they will want to provide free medical care to every Tom, dick and Harry who has never contributed to the tax cause. People will be flocking to California, as they are right now, for the freebies. So guess who will be paying for it all, everyone who has led a disciplined life and worked for a living and paid their taxes. Sacramento thinks that it has worked so well they will just tax those people more and more.

What is the answer? Just say NO to California and get out while you still can before they set up a tax station at the state boarders and start charging to leave because those that are coming in are not paying.


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I didn’t say ‘doctors – who needs them?’. I said (or meant) that, if after they have repaid their debts, they then choose to continue charging pirate’s rates for health care then we don’t want them. They are only driving people into poverty. They’ve gotten used to the fact that everyone believes that their rates are justified, that their services are so valuable that we’ll just pay anything, any rate they come up with. They’ve paid off that debt but they’ve gotten used to all that money, so why would they voluntarily give it up? Unless they aren’t just in it for the money and actually have consciences. Those are people we need. Note the following from the article, A Doctor Shortage? Let’s Take a Closer Look


“But there is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians. The system isn’t undermanned, it said: It’s inefficient.”

…


“None of this should be taken as a cry for sympathy for the financial plight of doctors in general. They are more likely to be in the top 1 percent of earners than any other profession. Still, it’s important to recognize that financial drivers are at play, and that they do matter.”


https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html?_r=0


Again, this needs to be tackled at many levels. Yes, we need some sort of price controls on things. Controls on how much universities charge to train people (by the way, they charge all their students exorbitant fees, yet it’s doctors that feel justified in translating that into permanently sky-high rates). Insurance companies, which I consider legalized extortion, badly need to be reigned in. The idea of insurance is good, but come on, the amount the average person pays in throughout life far Far exceeds any payouts they’ll ever get when necessary. That’s IF they can get it. More likely people with legitimate claims for whatever get the run around until they give up. Insurance companies justify their rates to doctors by pointing to the so-called prevalence of malpractice lawsuits, but that’s bogus.


https://www.oshmanlaw.com/news-center/the-truth-about-medical-malpractice/


“A 2006 study conducted by researchers at Harvard University, for instance, concluded, “Portraits of a malpractice system that is stricken with frivolous litigation are overblown.”[3] The truth is in the numbers: Compared to the estimated 238 thousand deaths that occur each year as a result of preventable medical errors (including birth injury) the justice system awards only 38 thousand payouts—if anything, the issue here is the abundance of medical errors, not the number of victims compensated. Moreover, according to the Congressional Budget Office,[4] these payouts amount to less than two percent of the overall cost of healthcare—not exactly the driver of healthcare costs that lobbyists made them out to be.”


And though the Martin Shkrelies of the world vehemently disagree with twisted, pretzel-like logic, we need controls on how much pharmaceutical companies charge for drugs. Ok so they have come up with some new pill, they should be compensated, (though I’d argue that payment should be part of a fair and universally balanced single payer health care system rather than hitting a much smaller segment of society with massive fees). But find out what the true cost of the drug was first.


IOW, we need an independent, unaffiliated and unbiased third party to oversee what people are being charged for things, from education to insurance to health care and to many other things in this Capitalist society of ours that has the power to reign in prices when fit.


https://www.nytimes.com/roomfordebate/2015/09/23/should-the-government-impose-drug-price-controls/drug-price-controls-are-vital-in-a-market-thats-not-free


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Sorry, my above comment was in response to “Citizen” below, not rukidding.


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Thank you!


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Your inflated hospital bill is 100% due to government regulation and “oversight,” no lack thereof. Price controls do not work…..hence the massive hospital bill.


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Your comments about doctors- who needs them- are likely the most uninformed, ridiculous comments I have seen in a long time. The shortage of doctors in California already has been discussed resulting in ideas such as promoting some nurses and nurse practitioners to doctor positions and paying bonuses to bring in more doctors from foreign countries.


A health care system without adequate doctors means long wait times for patients to be seen. People will revert to using hospital emergency care, or do without immediate care.


It is important that doctors not be driven from California, and it’s important that doctors can pay off their medical school debt unless you want the state to finance all doctor medical education/training by raising health care fees. If doctor salaries are capped, then nurses and health care professionals will also see their salaries drop, and there may be shortages there also.


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So hows that obamacare working for ya?

Anyone who is transitioning from obamacare into Medicare should already be getting a real eye opener as to how both these government run programs is really working.

Obamacare, medicare, Medical, Medicaid all have shown their true colors and how each is working to lower care and coverage to a minimal level comparable to HMOs. They control who you can see, how much coverage you get, where you go when an emergency arises.

This is what happens when government and bean counters are in control…


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Many Canadians would probably disagree with the premise that our doctors would run for the hills, because that in fact didn’t happen when the Canadian Health care Act of 1984 was codified.


As one Canadian medical worker put it in her article Feb, 2008 headed “10 Myths About Canadian Health Care, Busted”. “If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here”.


In the Canadian “single-payer medicare for all system” doctors run their own private practices, just like they do in the US, only they don’t have to hire numerous secretaries to do the paperwork for 130 different insurance companies & stay on the phone to get paid & put up with the “oh we don’t pay for that” bs. There are NO runaround & fights to get paid. The Doctors are now the gatekeepers of the systems adopted by each province, as she put it & don’t have to work a 70-hour week to make a living.


Seemingly, what occurred with health care in Canada, where it all happened as a ‘first’ in North America, in the small Province of Saskatchewan, will probably evolve in the USA, with California

If we pay attention to the many twists & turns Canada is still going thru, as clearly outlined in the Canadian ‘Naylor Report’ which is described by “The Tyee News”, Sept 2015 headed “An Unwelcome Prescription for Canada’s Aging Health System”.


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The plan has been to erase all private medical practices and get all doctors and nurses to work for one of two corporations….for very little money.


It’s working! The governor and most of the politicians have great healthcare.


The serfs? Well, who cares? They’re just serfs.


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What is very little money?


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The only way I see that the State can pay for this is to double every tax there is, and wipe out Prop 13. Then all Hell will break loose in California, but they will have confiscated all the guns from honest people by then so…


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This whole plan will fly like Hughes’ Spruce Goose. Don’t know what they are smoking up there in Sacramento, but it must have an hallucinogen in it.

People are already working fast to overturn the gas tax, this won’t get far either.

This governor needs to be in an insane asylum.


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MoonBeam already is in one, it’s called Sacramento, home to thousand’s of crazy people, we just call them politicians


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“This governor needs to be in an insane asylum.”


He already is- it’s called Sacramento.


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Perhaps this author could pen an article void of hyperbole intended to inflame, and instead use language that would promote a real discourse between an obviously divided electorate?


It really isn’t that much to ask. It is a regular occurrence for this author.


Using such phrases as…”California’s current ruling enviro-socialist regime” when referring to our duly elected government, only serve to drive a wedge further between the citizens of CA.


The author may not like the results of recent state-wide elections, but referring to our government in terms that are best applied to 3rd world, un-elected, dictators would be a start.


Yes I know it is intended to be evocative language. We have way too much of it on both sides of every argument.


Our country needs to learn how to talk to each other again. Publication’s such as Calcoastnews could help by not promoting articles loaded with such hyperbole.


The moderator often chastises those with pointed and personal attacks, but the editorial board of the publication would be well served to ask opinion piece writer’s to do the same and not lob insults at a whole class of people. In this case the majority of the CA electorate as they were the ones who duly elected this “regime”.


Just a thought from a “libtard” who is concerned about the fabric of our civil society be torn to shreds by purposely divisive language.


A simple review of this regular opinion piece author’s body of work, by the editorial board, would show this to be true.


Surely cogent arguments can be made without stooping to calling those that have different points of view from you ugly names and implying we are enemies worthy of derision.


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Who pays for this? Mr. Yan… and everyone else. This stinks. We can’t take care of other people until we take care of ourselves. Unless Mr. Yan wants to fund the whole kit and kaboble. Good for him! And while you’re at it Mr. Yan, remove your front door from your home and let anyone in.


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I didn’t make any comment on the content of this article, just the author’s tone and use of hyperbolic language. You missed the whole point. It was about listening and talking to each other respectfully. You weren’t trying to “listen”.


You are still trying to score points for your team or side. I took no position on the content only merely pointed out that this opinion writer is motivated to inflame more so than inform.


The point being it would be nice to pick fewer fights, on purpose, and attempt to listen to one another occassionally.


This liberal can choose to fight but I challenge myself to listen.


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I do always appreciate your input, it’s quite rational in the midst of much nonsense, including myself.


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And single payer isn’t bad when the feds are in debt providing assistance with insurance, not to mention a president wanting to take it away, and debt; what, 19 trillion dollars the feds owe, 5 trillion to China? How can one complain about seeking independence as a state, isn’t that what Texas is all about? Or am i wrong? And taxing the rich is how civilized world stays afloat, as long as they avoid this though, things will fail.


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And if you get rich off a system that provides mass sums of wealth, pay into it rationally you must. And what, the Trumpster wanted recipients of large sums of lotto fortune to loose access to social medicine. Just facts folks. So-ci-alism is the backbone to So-ci-ety.


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I appreciate your attempt at a civil, rational, non-hyperbolic response. I’m certain that it will elicit a deluge of informed and sober discourse among the CCN commenters.


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someone will have to explain how the state will keep from being flooded with people without health insurance (undocumented or otherwise). I just cannot see how this could possibly be a workable solution.


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It will work quite easily. Just open up your pocket book a little wider, relinquish part of your retirement funds over to the medical field, refinance your home if you get sick. It’s that easy. Or like everyone else is talking about just pack up with a full pocket book, take your retirement benefits and the equity in your home and abandon California. We certainly do not have to wait for the threat of global warming drowning California, Sacramento is way ahead of the curve on this one.


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