Proposition 186: Universal health care battle wages on

Published: Monday, October 31, 1994

By Charlie Chang

The battle for universal health care has moved from the national level to our state in the form of Proposition 186, an initiative modeled on Canada's single-payer system. While no one is against providing medical treatment for the sick, Proposition 186 is not the answer.

The initiative fundamentally places unprecedented power in the hands of an elected commissioner, who could be an everyday politician instead of a person who actually works in the health field. This person, who would be allowed to set health provider rates, nurse staffing ratio and the distribution of medical technology in the state, has the power of a small tyrant.

The commissioner would also have other broad powers to plan and regulate our health care services, all under a budget. And we've seen what has happened in Canada's single-payer system under a budget. Their system is limited in equipment and treatment, creating waiting lists that are sometimes one year long. Canada has one-eighth the number of MRIs per capita than the United States.

Also, we know the government's reputation for solving problems. They do it slowly. The Canadians still haven't solved their long-line problems. A competitive system would be much more responsive to consumers.

Under Proposition 186, there would also be a collection of 2.5 percent surtax on salaries up to $250,000 for individuals and $500,000 for families. Any income above these levels would have a 5 percent increase in income tax. Corporations would have to pay from 4.4 percent to 8.9 percent in payroll taxes. A $1 tax on cigarettes would also be implemented.

More taxes are acceptable if they get the job done, but some estimates say that despite $40 billion in new income and payroll taxes, the initiative still falls short of expenditures by $14.5 billion. To reduce payroll tax rates, larger firms will most likely downsize or relocate out of the state.

Spectrum Economics estimates that there will be negative short- and long-term job losses from the proposal. Short-term effects due to the wage tax could include a loss of 20,000 to 40,000 insurance-related jobs. Over the long term, by 1998, 300,000 jobs could be lost in California because of fewer purchases, since the bulk of the wage tax is absorbed by lower wages.

Under the current health care system, furthermore, doctors and patients are careful to take only necessary tests and procedures. This may not be the case with the fee-for-service reimbursements and minimal cost-sharing in the single-payer system proposed by Proposition 186. Canada has controlled massive increases in the utilization of health care only by decreasing provider fees and rationing high-technology treatments. That's bad news for the patients and doctors.

Obtaining health care for everyone should be our moral duty. I plan to be a doctor in the future, and I don't want to turn anyone in need away. But the path Proposition 186 wants to take will stunt our medical and economical sector and keep us from growing. We should trust our medical providers to continue their difficult job of finding more effective and inexpensive ways of treating patients. We don't need a "commissioner" to tell doctors how to treat people. Please vote no on Proposition 186.

Chang is a junior biochemistry student.