Health care is one of the hottest issues in California politics. Last year, state lawmakers shelved a controversial single-payer bill. So, what’s next? California State Assembly Member David Chiu sat down with Dr. Andrew Bindman at UCSF to discuss the complex realities of health care reform.
Chiu represents the 17th Assembly District, which covers eastern San Francisco. He’s also one of eight members of the Select Committee on Health Care Delivery Systems and Universal Coverage, formed in the wake of the failed single-payer bill. Chiu and his colleagues on the committee have proposed 16 bills aimed at increasing health care access for Californians. But, he says there is still a long way to go to achieve universal coverage.
Just over 93 percent of Californians currently have health insurance. Chiu says getting that number to 100 percent, would cost billions of dollars. Switching all Californians to a single-payer system, would cost an estimated $400 billion a year – $200 billion of that needed from new taxes. And, Chiu says the cost is just one major challenge. There are also legal hurdles, including the need for federal tax waivers, which he calls a non-starter under the current administration. But, that doesn’t mean single-payer is dead in California. Chiu talks about the impact the upcoming election could have, and who he thinks should really be leading the conversation.
Watch The Landscape for Health Care Reform in California
They may not seem related, but Dr. Sandro Galea, Dean of the Boston University School of Public Health, says we can approach guns, obesity and opioids in the same manner: population health. Dr. Galea breaks down the key concepts of population health – a relatively new field – during the inaugural Colloquium on Population Health and Health Equity at the UCSF School of Medicine.
Dr. Galea argues guns, obesity and opioids are the three epidemics of our time, and three of the main reasons life expectancy is declining in the United States. They also share three key characteristics: They are important, costly health concerns. They are complex. They are resistant to simple solutions. The key to overcoming these challenges Dr. Galea says, is using the population health approach.
He lists nine principles of population health, but focuses on four, including the concept that small changes in ubiquitous causes of health problems can have a greater impact than big changes to rare causes. Dr. Galea uses the example that while much has been done to curb the overprescription of opioids, the epidemic continues to grow. That’s because other options, like synthetic opioids, have become more widely available. Dr. Galea says that’s where population health comes in – finding ways to improve health on a large scale, and addressing epidemics from every angle.
Watch Guns, Obesity, and Opioids: A Population Health Science Approach to Contemporary Concerns