By Daniel Weintraub California is a land of health extremes, and to see what that means, you need only travel a few miles from the state Capitol. Placer and Yuba counties border each other about a half hour’s drive north of downtown Sacramento. Both places are largely rural. But the similarities end there. Placer’s residents are, on average, much healthier than their neighbors across the
California Focus: Daniel Weintraub
Even as lawmakers in Washington D.C. drove themselves into a bitter partisan divide over federal health reform in 2010, an unusual experiment across the country in Oregon was amassing evidence that the rancorous debate in Congress was focused on many of the wrong things.
And if what Oregon’s experience is telling us now is accurate, the Affordable Care Act will be neither the boon to America’s health that its supporters claim nor the threat that its detractors fear it will be.
Why? Because expanding access to health insurance and even health care — the primary goal of the ACA — might not make us healthier, at least not in the the short term and not in the ways most people seem to believe.
California is two years into an historic reform of its criminal justice policy, shifting low-level offenders from state prison to county custody. The change has resulted in 18,000 inmates going free who, in past years, would have been behind bars. Now a new study suggests that this change has led to a significant increase in auto theft. How should the state respond?
California’s school drop-out rate is driven largely by a cycle of kids getting in trouble, being suspended or expelled, and never getting back on track. Reformers have been arguing for an overhaul of the school discipline system to focus it on keeping kids in school while they are held accountable for their actions. Now the state’s Chief Justice has thrown her support behind these efforts, saying reform would be smart and more just, and save money too.
California’s government finances are riding the roller coaster again. Buoyed by a soaring stock market and rising home prices, personal income tax receipts are flowing into the state treasury at a rate exceeding all expectations. The result: a surplus of $6 billion or more is likely if Gov. Jerry Brown and the Legislature simply stay the course on spending and taxes for the next 18 months. And that’s after taking into account billions of dollars in higher spending on the schools that the state Constitution will require if tax revenues grow as now projected by the non-partisan Legislative Analyst’s office. But one big question looms as lawmakers and the governor consider how to spend the government’s new found riches: what will happen when the music stops?
As President Obama struggles to fix problems with a federal website at the heart of his health reform, California’s new online health insurance exchange is winning praise as a model for the nation. But behind some positive early numbers lurk challenges that could also serve as warning signs for the rest of the country.
A lot of people rolled their eyes when New York City banned the use of trans fats in restaurant meals a few years ago. Some called it “nanny government.” But now the federal Food and Drug Administration has ruled that the fats are unhealthy and announced plans to phase them out of processed foods.
Could sugar-sweetened drinks be next?
An outright ban isn’t in the cards. But a broad coalition of California public health groups is trying to slap a special tax on sugary drinks to finance anti-obesity programs aimed at children.
California is about to begin a new era of school reform that promises less focus on facts and figures and more attention to critical thinking and problem solving. But the state needs to make sure that dramatic gains in basic skills made by low-income students in the generation since the last major reforms were adopted are not lost in the quest for deeper understanding of complex topics.
Californians have a love-hate relationship with direct democracy.
We love that we have the ability to set the politicians straight, either by getting a jump on them on the next big issue or reversing course when we think they’ve made a big mistake.
But we’re not wild about reading through all those damn initiatives that appear on the ballot every year, or sorting through the claims and counter claims of the interest groups that sponsor and oppose them. And we don’t like the way that big money pays to get most measures on the ballot and then underwrites the campaigns.
Those are among the findings of recent research by the independent Public Policy Institute of California, a non-partisan think tank which also suggested a few reforms.
Supporters of the Affordable Care Act say the controversial law is the country’s best hope for improving the health of all Americans and slowing the growth in health care costs. Opponents say it will do the opposite: driving up the cost of care, disrupting relationships with our doctors, and making Americans more dependent on their government.
But what neither side acknowledges is that even if the law works exactly as intended, it is unlikely to have much effect on how healthy we are, how sick we get and how long we live.
The Affordable Care Act, at bottom, is more about health insurance than health care. And even the parts about health care are not necessarily about health.