New CMA leader Joe Dunn takes a detailed look at health-care reform

By Capitol Weekly Staff

(published February 8th, 2007)

The California Medical Association was the driving force behind SB 2, the bill by Sen. John Burton that required employers to provide health care for their employees. The bill later was repealed after a multimillion-dollar ballot-box fight. Now, back at square one, CMA has a new executive officer, former Democratic state Senator and former trial attorney Joe Dunn, and a new plan for covering California's uninsured. Capitol Weekly spoke to Dunn in his Sacramento office.

CW:What do you think is doable in terms of a health-care proposal in the Legislature this year?

JD:That's the ultimate question and nobody has a true answer as of this point in time. Health care has been such a challenge for public policy-making bodies for so many years that up to now no public policy-making body has been able to overcome the obstacles to significant reform. We've seen many gallant efforts in the past on the state and federal levels and all have resulted in some sort of failure. So, if someone were to predict the outcome of this debate based upon the track record, one would reasonably predict this will fail, as well. …

No matter whether one agrees or disagrees with this governor or his health-care proposal, we have to give him credit for being willing to stake his political strength in a debate that thus far in our history has never been successful.
In addition, you now have the leadership of both houses and both parties willing to engage in this debate We've often times seen proposals from one leader or another which are ignored by every other leader.

And finally we have poll numbers that it has now hit the No. 1 priority ranking for your average person on the street. Often times you will see education or transportation or crime, and health care has always lurked. But now in some polls you see health care as the No. 1 issue.

Now we've got the sun, the moon the stars lined up for real health-care reform, perhaps the first real opportunity we've had in 15 to 20 years in California.

CW:What is the most important issue for CMA in this debate?

JD:The most important issue in this early point of the debate is that nothing is done that squanders this once-in-a-lifetime opportunity. Once we know that those who oppose any reform will not be successful in destroying this opportunity, then and only then will everyone be ready to sit down and truly hammer out a reform that works, not only on its merits, but [that] also recognizes political realities. Sometimes what is solid on its merits may not survive the political process. It has to both work and be realistic with respect to the political process.

I don't think any public policy maker or players in the health care system as of yet could tell anybody what the final product will look like. Too many people right now are in advocacy mode, meaning, 'My plan is right, your plan is wrong.' We're not going to be able to seize this opportunity if folks take that approach.

CW:So would CMA be open to other proposals and not wedded to an SB 2?

JD:We realize that we have to work with public policy-makers for a plan of reform that works and that is politically real.

CW:What does that mean?

JD:We have always advocated that universal coverage is critical. I don't think anybody disagrees with that. We have always said that. We will constantly insist that this reform be about improving the patients' ability to get to their doctor and be treated by their doctor. That is the center point of this debate.

CW:Are there pieces of the governor's plan, besides the 2-percent tax on doctors' dividends, that your organization has trouble with?

JD:Sure. The proposal to allow non-physicians to practice medicine, to allow physicians' assistants to perform more work without supervision from medical doctors, that is very problematic from a safety perspective. It doesn't improve the patient-doctor relationship, it erodes it.

CW:Wouldn't an expansion of coverage lead to a shortage of qualified physicians? Isn't care from a nurse practitioner better than no care at all, especially for little things?

JD:There's no question that even right now in certain areas, be it geographic or specialties, there is a need for more physicians. That's not a new issue. And if more folks have access to medical care, yes, there could be some complaints of shortages. We would rather wrestle that problem than compromise the safety of the patients themselves.

CW:There are so many different stakeholders in this debate. What is the major axis of this debate?

JD:The two big questions are who's covered and how do you pay for it? Everything else is kind of ancillary. Is it going to be an employer-based system? Is government going to step into the fray in a more real way, or will responsibility be shifted more to the individual? Those are the primary
pieces. We really ought to be starting with the patient and the doctor. That's what health care is all about. We need to start with that core principle and build out from there.

CW:What about the idea of individual mandates? Is that something that CMA supports?

JD:People often get worked up over the terms "employer mandate" or "individual mandate." Is an individual mandate a mandate to pay or to accept insurance offered to you? SB 2 was an individual mandate. It didn't give individuals a chance to decline insurance that was offered. So, we've supported individual mandates in the past. Now, if you are solely going to be responsible for paying for your own insurance, that's an individual mandate to finance, not just to accept. Few people make that distinction.

CW:Tactically, how much of this political fight is about educating the public? How much will go on inside the Capitol, and how much will go on parallel to the political fight here in Sacramento?

JD:The average Californian cares about one thing: having access to their doctor and being able to be treated. Period. End of story. Those inside the political process who are about to engage in this debate cannot forget that fact. They care about picking up the phone and getting an appointment with their doctor and being treated. The doctor-patient relationship is not part of this debate, it's the point of this debate. As the political insiders allow themselves to get sucked into a payer-provider system debate, they're going to lose touch with what their constituents want.

So if people in the political process think they have to educate Californians, they're sadly mistaken. Anyone who thinks that is the one in need of an education.

Political insiders, and I being a former one, too often get sucked into the unnecessary complexities and forget what it's really all about. So, my hope for the insiders is that they realize the real wise person in this debate is the average Californian.

CW:Did you have a pretty good sense this debate was coming when you signed up for the gig?

JD:(Laughs) Yes, indeed. And I have not been shy in telling folks that being at the center of this debate was very intriguing for me.

Return to : Single Payer Articles