Is Medicare the Cure for State's Gridlock?

President George W. Bush recently accomplished something almost no one else could in California politics: He got Gov. Arnold Schwarzenegger and the Legislature to put politics aside to pass a new law to meet a real need in real time.

Through the ill-prepared implementation of the new Medicare drug plan, Bush gave the governor a chance to work with the Legislature on an emergency fix to the new federal drug program. The poorest of elderly California seniors, who had been getting their prescription drugs from Medi-Cal, were in danger of getting no drugs because Medicare wasn't ready. In just four days, a bill to help these seniors was proposed, passed and signed.

The big question is whether this success will create momentum for other much-needed positive change in health care. More than 6.6 million Californians have no insurance. And with health premiums up more than 60 percent from 2000 to 2004, no one is getting a free ride. There is no 12-step program to cure political gridlock. But here are four bipartisan health issues that show promise.

Fight obesity. Rising obesity rates are reducing quality of life and increasing health care costs -- $28 billion in California in 2005. According to state officials, 50 percent of adult Californians are in danger of being overweight or obese. Last year saw a good start, with the governor holding the first-ever obesity summit and then signing bipartisan legislation by Sen. Martha Escutia, D-Whittier, to take soda and candy machines out of schools. Working on obesity is the low-hanging fruit in the health-policy world, with potentially big savings.

The Schwarzenegger administration has promised more obesity-fighting proposals later this year. The governor should be sure to keep talking to legislative Democrats, who have more than 15 bills pending on obesity.

Launch the Quality and Cost-Containment Commission. At a recent legislative briefing, Rand Corp. expert Dr. Robert Brook expressed frustration that the Capitol has ignored what he called the real health care crisis -- that of poor-quality care and poor efficiency. The indignation was appropriate. The state already is required to have a commission addressing these issues. But more than two years after the law's passage, the commission has not been convened.

Administrative costs are among the most unnecessary and the fastest growing expenses in health care, increasing 13 percent from 2002 to 2003, according to the California HealthCare Foundation. If Sen. Hillary Clinton, D-NY, and Newt Gingrich can work together on improving health care quality, certainly California can launch a commission to find local solutions.

Additionally, hospital bills are confusing. The Legislature needs to make hospital pricing more transparent.

Bonds for hospital seismic requirements. April is the 100th anniversary of the San Francisco earthquake and fire. In response to the 1994 Northridge earthquake, a law was passed to make sure that hospitals can survive a major tremor and provide medical care in the aftermath. While full replacement of the hospitals is an earth-shaking $41 billion, a targeted effort making only the most critical improvements could be completed for as little as $3 billion, according to a 2003 study.

In this post-Katrina, post-Sept. 11 age, emergency preparedness should be an issue that Republicans and Democrats can agree on, especially since federal funds can help. The political ground here keeps shifting under the seismic issue, with a major union and Assembly Speaker Fabian Nunez, D-Los Angeles, recently announcing support for retrofit bonds.

The only penalty for hospitals not completing the retrofit is closure. That's not realistic or wise. Legislators should give the hospitals more time and money. But financial penalties are needed for failure on interim steps, such as a date certain for completing an engineering survey or for securing a construction firm. Otherwise, another 10 years may pass with little change.

A commitment to covering all children. Citing a lack of funding, the governor last year vetoed a bill by Assemblywoman Wilma Chan, D-Oakland, that extended access to health insurance to all children. This year, as some states are reducing access to public health insurance, California's governor added $72 million to his budget to help enroll children who are already eligible for public health coverage. That's a smart first step since more than half of the estimated 779,000 uninsured California children fall into that category.

But more support is needed. To be boldly bipartisan, California needs a plan that will cover all children and make insurance cheaper for all families. Shared responsibility among parents, employers and the government is necessary to make children's health insurance accessible, affordable and mandatory.

A New America Foundation proposal, building on bipartisan ideas in the Legislature, would cover all children. The investment is less than 2 percent of state spending and less than last month's budget surplus revisions. All the key political players in California have demonstrated support for, and interest in, covering kids. As such, a shared commitment to shared responsibility should be within reach.

The payoff of working together on all these issues includes healthier children, safer hospitals and a more productive work force, now and in the future -- not to mention that California leaders can prove to themselves and the citizens that elected officials can actually work together to do important things.