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“Hey, Doc, I need you to fix this for me so I can smile again.” This was my life as a practicing dentist in a small town in Northern California’s wine country before I became a lawmaker in Sacramento.
I made it my job to help my patients understand the value of my services. I practiced with honesty and integrity, and my patients came to trust that I was providing the best possible care at a fair fee. Trust was foundational for satisfied patients and a successful business. We needed each other.
When I was elected to the state legislature in 2014, I applied the same discipline to that work. I aimed to be an honest broker, developing relationships in the Capitol that gave my rural constituents a seat at the table. Those relationships, along with my expertise as a health care provider, made me a trusted messenger on health care policy.
Trust Is Vital
For our 30th anniversary, we’ve invited health care leaders and experts to share solutions for building trust at all levels of the system. The views expressed in this series are those of the authors and do not necessarily reflect policies or opinions of the California Health Care Foundation.
Without trust, the legislative accomplishments I am most proud of would not have been possible. Those include the state limitations on “surprise medical billing” that became a model for federal legislation, the expanded scope of practice for providers like nurse practitioners to maximize workforce capacity, the establishment of a data exchange framework, and the foundational work to tackle runaway health care costs that led to the creation of the California Office of Health Care Affordability (OHCA).
To keep improving the health care system, we need strong guiding principles. We must cover everyone and invest heavily in prevention, full stop. This will result in fewer emergency room visits, less chronic disease, and longer, healthier lives for Californians.
True change will require steadfast leadership, persistence, and a lot of trust. Building trust takes time, and this work can’t be completed within a single budget or election cycle.
Unfortunately, the legislature operates on a two-year clock. Lawmakers deploy piecemeal stopgap measures that address discrete issues while overlooking structural defects that threaten the overall system. It’s an approach shaped by powerful outside interests that put profit ahead of patient well-being and by competing political priorities that prevent good laws from being passed.
More Than $1 Billion a Day
Californians deserve something better than the system we have.
We are caught in a colossal struggle between two extreme visions for health care. One side is driven by the forces of private equity, corporate consolidation, higher profits, and unchecked market dominance. The other envisions a government-run system that offers unlimited services at little or no cost to patients. In the middle are everyday people who simply want access to affordable, high-quality health care.
The state’s public and private health care system costs us more than $400 billion a year, more than $1 billion a day. That’s more than $10,000 a year for each resident of the state. For years, the skyrocketing cost of care has been a top concern among Californians. Unaffordability leads to poorer health as people avoid visiting the doctor.
Now, with growing budget challenges and the federal wrecking ball of H.R. 1 in full swing, people are losing care altogether.
To bolster public trust in the system, we must build for the long haul. We could start by lining up the puzzle pieces scattered across the executive and legislative tables. Instead of passing dozens of bills targeting separate elements of the health care system, we need a cohesive, unified strategy.
Bringing Health Care Costs Into the Open
Sharing data across sectors so that everyone is working from the same facts will help. Early in my Sacramento years, I realized how opaque health care finance was. When it came to the insurance claims that actually paid for care, lawmakers, regulators, and even providers had little understanding of where the money went. The lack of data obscured health care spending trends.
So in 2018 we created a database to track every insurance claim, including those from Medi-Cal, the state Medicaid program. For the first time, policymakers and researchers could see and respond to the same facts.
We held legislative hearings in Sacramento, Los Angeles, and Fresno to explore a publicly financed health care system. Many people told us that affordability was a key marker of improvement, and this foundational principle led to the establishment of OHCA. That’s a major challenge. Slowing the rate of cost growth in meaningful and sustainable ways requires hard decisions, and those are unpopular with the entities driving the cost of health care higher.
Even the smartest policies will make little difference without accountability to ensure compliance with the rules. OHCA is a health care cost watchdog with teeth that get sharper with age. To realize OHCA’s bold goals of slowing spending growth and promoting high-value alternative payment models, we created escalating fines to go after providers that egregiously failed to make good-faith efforts to comply with spending targets.
Saving the system money demands scrutiny of small, commonplace expenses that add up. Studies have shown that more than 25% of health care spending is attributable to waste, duplication, or bloated pricing. Californians foot that bill without getting better care. Providers should reflect more on necessity and ask themselves: “If I had to pay for this service on my own, would I still order it?”
What California’s Next Governor Should Do
California will have a new governor soon. A new administration offers a fresh opportunity to take on the fight for affordable, accessible care for all Californians. The state needs a governor who will prioritize health care reform, disrupt the status quo, and focus on earning the public’s trust.
The most corrosive idea in health policy is that our system’s problems are unsolvable. I know firsthand that is false. California has the data and the momentum to transform our system into one that works for everybody.
But changing the system is not a one-and-done exercise. In the face of unprecedented federal funding cuts, we will have to redouble our efforts to find policy solutions that meet the health needs of all Californians. That means negotiating drug prices, expanding coverage eligibility, and reducing administrative waste.
Our next governor must approach improvements to health care with conviction, care, and follow-through. Only then will the people of California trust that their leaders take their health care seriously.
