01/29/2008 02:53 pm ET Updated May 25, 2011

Ten Lessons for the Candidates from the California Healthcare Fiasco

Before the leading Democratic candidates come to California for the upcoming super Tuesday primary February 5 and spend a lot of time talking about their health plans, they might want to cast a look at the demise of Gov. Arnold Schwarzenegger's much ballyhooed healthcare bill.

Despite a year of fawning praise by a number of media and supposed policy experts and intense lobbying for the bill by some of the state and nation's most powerful political players and vested interests, the bill collapsed Monday in the Senate Health Committee, gaining just one vote from the 11 committee members.

For months the Schwarzenegger bill, which landed him on talk shows and the covers of national magazines, was marketed as the model for national reform.

As was before it, the Mitt Romney-inspired Massachusetts law, now careening with $400 million in red ink and 60,000 people, so far, who have been exempted from its punitive, mandatory insurance plans.

Proponents of the California bill promised that they had learned from the Massachusetts debacle and fixed its myriad flaws as they crafted revised version after revised version in closed door meetings. One thing they may have learned -- roses don't grow in the dark.

What does this mean for the three Democrats running for their party's top prize or other legislators contemplating similar bills? A few reminders, and several huge potholes and pitfalls to avoid:
  1. It's not the swiftest idea to force people to buy insurance without telling them how much it will cost and what they get in return, and then threaten to seize their wages and their house if they don't go along.
  2. If the leading proponent of the bill doesn't want the plan either, you might want to send the script back to re-write. During a committee hearing, state Sen. Gloria Negrete McLeod asked Schwarzenegger's Secretary of Health Kim Belshe if she'd want the bill's coverage. After hemming and hawing, Belshe conceded she'd have to defer until she knew what those benefits are.
  3. Don't propose a $14 billion plan in the midst of a $14 billion budget deficit. And when your lead proponent, Schwarzenegger, wants to raise Medi-Cal (Medicaid) reimbursements and benefits in his bill while simultaneously urging the legislature to cut Medi-Cal benefits and reimbursements in his budget, people might think he's auditioning for a role in a remake of Dr. Jekyll and Mr. Hyde rather than governing.
  4. Promoting lung cancer and emphysema to pay for a health bill is not a smooth move. Nor is a bill that relies on a hefty tobacco tax while concurrently advocating smoking cessation programs. Can you say declining revenue stream?
  5. Providing corporate welfare by encouraging Wal-Mart and other big employers to dump their low-wage hourly employees into an underfunded public pool is not a slick way to ask for union support.
  6. It doesn't count as "cost controls" when you ask the insurers to tell us how much they are charging. And subsidies or tax credits for premiums don't make a plan "affordable" when people have to pay extra for co-pays, deductibles, dental, vision, mental health, and long term care.
  7. Assuring people choice of provider does not mean they can continue to enjoy the pleasure of being price gouged every time choose an "out of network" doctor or hospital. They already have that privilege.
  8. When your main advocate is a governor who has vetoed every healthcare expansion and insurance regulation bill put before him, while accepting tens of thousands of dollars in campaign contributions from the healthcare industry, you might have a credibility gap.
  9. Don't pretend the insurance industry is opposed to the bill when seven of the state's biggest insurance giants are stumping for it.
  10. If the bill caps the fees being paid by employers and hospitals, but sets no limit on what individuals and workers will have to pay year in and year out, don't be surprised if people think their pocket is being picked.

P.S. Californians, like other Americans, do want genuine healthcare reform. This wasn't it. Let's try again.