Dan Walters

Dan Walters: Propositions 45 and 46 latest skirmishes in war over big money in health care

Dan Walters
Dan Walters

By any measure, health care is now California’s largest single economic sector, churning well over $200 billion a year in private and public funds each year, and growing fast.

Obamacare, the aging of the population and other factors expand demand for medical services and pump more money into the system. Health care is also a major – and very fast-growing – employment field, with 450,000 new jobs expected in California over the next decade.

It was once ignored by Capitol politicians, but it’s now big business involving big money – as well as a personal priority for 38 million Californians – and sparks high-octane political conflict.

Divvying up health care dollars generates countless bits of legislation each year, and, not surprisingly, a steady stream of ballot measures, including two this year.

However, Propositions 45 and 46 may turn out to be busts because even before the full-bore campaigns have begun, as voters appear to have soured on both.

Proposition 45 would expand the insurance commissioner’s authority over health insurance rates, while Proposition 46 would lift the 39-year-old cap – signed by Gov. Jerry Brown during his first year in the office – on pain and suffering damages in medical malpractice cases.

The common denominator in both is Consumer Watchdog, a Southern California outfit whose 1988 ballot measure, Proposition 103, made the insurance commissioner an elective office. The group has received many millions of dollars in “intervenor fees” from Commissioner Dave Jones and his predecessors, and could be in line for more under Proposition 45.

Consumer Watchdog teams with Jones on Proposition 45, and with Consumer Attorneys of California, the personal injury lawyer lobby which has attempted for decades to change the $250,000 malpractice cap, on Proposition 46.

Opponents, primarily health insurers and medical care providers, have amassed tens of millions of dollars to defeat them, and a new Field Poll indicates that both are faltering less than two months before the Nov. 4 election.

Proposition 45 enjoyed 69 percent support among voters in a Field Poll earlier in the summer, but that had declined to 41 percent two months later. Proposition 46 dropped even lower, from 58 percent to 34 percent.

Mounting criticism from existing health care monitors, including Covered California, the state Obamacare agency, and many of Jones’ fellow Democrats have undercut Proposition 45. Allegations that Proposition 46 would raise medical care costs and enrich lawyers have proved toxic.

Both may be doomed, but their rejection would not change the underlying dynamic that with health care our largest industry and destined to expand, the political infighting over who gets what from the system, both medically and financially, will grow as well.