A few weeks ago, right before the first California Senatorial Debate between Barbara Boxer and Carly Fiorina, I received a call from a local TV station asking me if I would be willing to be on standby to give an on-air quote about whatever the candidates said about healthcare and health reform. The producer’s theory was that since healthcare was one of the most vociferously debated topics at the federal level, surely this topic would be featured prominently in the debate. “Sure,” I said, and studiously watched the debate and sat by the phone like a 16-year-old waiting for a date to the prom.
Well guess what? That call never came. My 15 minutes of fame? Denied! I can hear my Father now, “If you sit by the phone, it isn’t going to ring. You have to play hard-to-get.”
Why did the call launching my TV career fail to arrive? Stunningly, not one single word about healthcare was uttered during the Senatorial debate. Not one. Hard to believe given that healthcare is allegedly one of the most critical issues our nation faces, consuming an ever-increasing portion of our gross domestic product and imperiling our national economy. But hey, who’s counting?
So tonight, I settled in to watch our first California Gubernatorial debate between former Governor Jerry Brown and former eBay CEO Meg Whitman with great interest, curious to hear what they would say about our state’s healthcare challenges. At a minimum, I figured, they would have to talk about Medi-Cal, California’s Medicaid program. Medi-Cal is the second largest expenditure in the state’s budget, consuming 19% of our General Fund in 2009 (second only to the 37% spent on K-12 education). Oh, and I bet you won’t be surprised to learn that this cost is rising with a bullet. Medicaid expenditures nationwide are growing apace with health insurance costs generally, and in California those expenditures have grown by an average of 7% every year for the past 10 years.
In case you’re wondering, California’s Medi-Cal program is the nation’s largest Medicaid program in terms of the number of people its serves (6.8 million) and is the second largest in terms of dollars spent ($47 billion). According to the California Health Care Foundation, Medi-Cal is the source of healthcare coverage for:
- 1 in 3 California children and 1 in 6 Californians of all ages;
- More than 1 in 10 adults in the state under age 65; and,
- the majority of people living with AIDS.
Furthermore, Medi-Cal pays for:
- 46% of all births in the state;
- Care supplied to 2/3 of all nursing home residents; and,
- Almost 2/3 of all net patient revenue in California’s public hospitals
In light of its important place in the state budget, I figured we’d hear at least some cursory policy position about how to address this growing challenge, even if the candidates did not address national healthcare reform overall.
Once again, crickets. It’s all jobs, jobs, jobs, and I do understand that to a certain extent. But these two issues are inextricably linked. If our state budget gets eaten up further and further by the demands of an out-of-control Medi-Cal program, there will be more state and municipal employee lay-offs and less money to support other job-creation programs. How can our political leaders ignore this topic? And worse, how can the journalists who question those who wish to lead us let this topic go by the wayside? It is shameful.
Healthcare has become the elephant in the room for policy-makers: a big fat saggy-baggy time bomb. No one wants to be seen as supporting what might be a high cost and potentially disruptive reform law and no one wants to be tagged as the person who denied important new benefits to the electorate now that they are within reach. And yet, our elected officials had better acknowledge and own this public policy challenge or we face certain economic decline.
As Randy Pausch, author of The Last Lecture, once said, “When there’s an elephant in the room, introduce him.” Time for California’s elected officials to get to know the healthcare crisis and let us know what they are going to do about it. There are two more California gubernatorial debates coming in the next few weeks. I hope the pachyderms show up.