Here are five elements to help transform California’s health care system for all

The COVID-19 pandemic has laid bare racial inequities, health inequalities and health injustices for all to see, and challenges the very structure and delivery of our health care system. 

As president and CEO of California’s largest health foundation, the California Endowment, we have championed universal coverage since our founding nearly 25 years ago. At the same time, we understand that “coverage” is insufficient  to improve the health of all Californians. 

We know from research that the most significant contributors to health are largely found outside of the medical system and are the conditions within which people are born, grow, live, work and play. Further, these conditions are shaped by issues of money, power, resources and race. And we’ve known this for decades – that social determinants drive health status. 

Having the privilege to serve on Gov. Gavin Newsom’s Healthy California For All Commission, and in light of the COVID-19 pandemic, it is timely and appropriate to share my – and the California Endowment’s – perspective on the health system we need for our state and nation. 

The California Endowment’s vision includes five essential elements for a transformed system that: 

1. Provides 100% coverage, everybody all in, regardless of immigration status;
2. Embodies a unified financing mechanism with appropriate incentives to achieve other essential elements and ensure affordability;
3. Advances health equity by addressing racial equity;
4. Optimizes prevention by linking to and supporting the social determinants of health;  
5. Possesses a health workforce that is culturally representative and proficient in serving California’s diverse landscape.

There is more than one policy option that can embrace all of these elements.  For example, a single-payer system and Medicare for All offer unified financing approaches that cover all Californians, which would be terrific.  However, even an all-in, government-sponsored health insurance system is simply not enough. 

The prize is not insurance coverage – the prize, as our commission is aptly named and tasked to present to the governor, is to create a Healthy California For All, which should include all of the above elements.   

California, along with other states, offers innovations to bridge health care, public health and social services, such as coordinated care organizations and accountable communities for health. These are promising intermediaries that also focus on equity and root causes of poor health. Such innovations are especially critical at this moment in our state and nation’s history.  As colleagues have noted, without fundamentally transforming the delivery system, we are merely moving dollars around in a broken system. 

In addition to the “what” of reform, there is an important set of “how” questions as we make decisions for our large and diverse state. Specifically, how do we assure that, in the course of our deliberations, we are hearing from communities and families most directly impacted by the inequalities and inequities of our current system?  We need that input, and we need to be excellent listeners.  This was well done under Peter Lee’s leadership in the formative stages of Covered California, where I served as one of the founding board members.

Further, we need to develop a winnable roadmap to a transformed system.  Do we lay out a roadmap for the governor that involves one bold stroke?  Or, rather, should we put forth a series of “boldly incremental” steps?  What implications will the outcome of the November presidential election have for the needed roadmap?  Finally, what can we learn from other states, like Vermont’s valiant but failed attempt to enact a single-payer system?

For sure, whatever our commission agrees upon as the roadmap to system transformation will have the support of The California Endowment.  While achieving the momentous task of implementation is daunting, I remain optimistic that with the input of my colleagues, and the leadership of our governor and secretary of Health and Human Services agency, California can once again be in the lead on health reform.