With the end of this year’s legislative session already in sight, 2006 having been touted as the “Year of Healthcare,’ California’s healthcare reform activists are being pushed hard to “do something.” We are confronted with a challenging question—how to do as much of the right thing as we possibly can without doing more harm than good.

(Full disclosure—my boss, State Senator Sheila Kuehl who chairs the California State Senate Health Committee, has 1.) authored single-payer legislation (SB 840); 2.) voted, for now, to keep AB 8, a Democratic compromise bill that would expand state health coverage, mandate an employer buy-in, preserve private insurance along with unequal coverage and not offer universal healthcare alive; and 3.) displays the following sign on her disk: Do No Harm.

The common sense arguments in favor of single payer healthcare coverage have been detailed here at TPMCafe. To sum up, it’s possible to cover everyone with comprehensive insurance (medial, dental, vision care, hospitalization and so on); allow each patient to choose her own doctor and save some money. The way to pay for this is to remove, from the process, private insurance companies. They serve no necessary purpose, and they spin the money of the shrinking population that they’re willing to cover through an administrative hamster wheel several times, thus raising costs while diminishing care. With single payer, each income earner, (individual or corporate), pays one yearly premium based on income. Because everyone is in the risk pool, the pot is large enough to cover each of us when we need it. Single payer offers actual consumer empowerment because, since each consumer is insured and all doctors and medical groups are ‘on the list,’ providers compete for patients.

Currently, however, in California, common sense has suffered a bit of a beat-down. An intransigent Republican minority is holding up passage of a bare bones compromise State budget that already calls for painful cuts in health services and transportation, because it contains insufficient corporate tax breaks and protection from environmental laws. Republicans are taking advantage of the 2/3 majority rule on which budget passage depends.

It’s worth noting that the funding portion of single payer legislation would be subject to this same 2/3 rule—a very large hurdle. Furthermore, Governor Schwarzenegger has threatened to veto any ‘intent’ bill that mandates a single payer structure in advance of the spending package.

Given these realities, pressure is high for single payer advocates to put their weight behind the compromise bill. The arguments are persuasive. If we can exit this legislative session knowing that more children have insurance and more working families (individuals do not make out so well) have access to coverage, aren’t we obliged to act?

Maybe. Sometimes, the worst thing to do is, indeed, nothing. But, sometimes, preventing a mistake is doing something.

As of this writing, AB 8 does some good things. It prevents an individual mandate on each consumer to buy health insurance whether it’s affordable or useful or not. It requires businesses to pay a fair share, and it creates a buying pool for high risk health insurance consumers that should help to control costs for people with ‘pre-existing conditions.’ However, one of the most informed voices for achieving the achievable, Anthony Wright, Executive Director of HealthAccess blogs that, for individual consumers, “it still won't be easy to buy coverage, and affordable packages are not expected.”

Because it accedes to the continuing presence of the private insurance monopoly, AB 8 makes things much more complicated than they need to be; from a common sense perspective anyway. Preservation of our current multi-tiered mosaic of public and private structures will necessitate the sort of complicated bureaucracy that government-haters love to deride. While AB 8 will solve problems for some people, it will isolate others who will feel left behind by the much-touted result of the ‘year of healthcare.’

One doesn’t wish to be, or be labeled, as obstructionist. It’s dangerous to slow momentum on a real issue. We don’t want the people who trust us to represent their concerns to lose hope that we can actually accomplish anything. It’s also dangerous to squander the momentum on a bad deal. We also don’t want people who believe that we’ve achieved ‘reform’ to wind up so embittered by the result that they sour on the idea altogether.

So there will be choices to make at each juncture of the process--with each amendment and each deal. Also, and critically, the people of California are not quiescent and have ideas of their own. Public Policy Institute polls demonstrate that public support for single payer is gaining width to match its depth. A majority of Californians would be willing to give it a chance. How do we explain that a handful of ideologues can hold back the best chance for real reform?

Furthermore, the Governor’s political capitol is shrinking. His ‘proposal,’ including a suggested mandate to force consumers to buy policies written by the insurance industry, which contributed millions to his campaign, remains a shopping list that no legislator would carry as a bill. Our current budget stalemate reflects the Governor’s inability to lead the legislators in his own party. That’s not necessarily an argument to foreclose negotiation—it may be a reason to negotiate now and push for a good deal. Or not.

There might be good reasons to pull SB 840 back until next year. If the Governor is going to sign a “compromise” bill, then we don’t want to offer up single payer as the “extreme” alternative that he can make a show of vetoing in order to bolster his self-promotion as a centrist. On the other hand, whatever half-measure does become law will certainly be touted by an impressive media office as the ultimate and, I bet you, “Uniquely Californian and post-partisan” solution that swept all other proposals aside.

What do you, who are reading this, think? How best to keep the concept of single payer before the people as the Gold Standard at which our efforts are still aimed?