What will happen to me if I get sick or injured and can’t pay my bills?

On the domestic front, that’s a key question on voters’ minds as the November elections approach. A poll of working women, released on August 8 by the AFL-CIO, indicated that concern about access to quality medical coverage was rated the top issue by 97 percent of respondents, outpolling the income gap between women and men for the first time. MoveOn members, asked to vote on issues that they believe should define a “new positive agenda” ranked healthcare for all persons at the top of the list.

In California, one of the country’s largest states and a decisive election-year battleground, the growing momentum behind healthcare reform is pushing two sharply different approaches into public view.

The first, a proposal for universal healthcare coverage, is presented in Senate Bill 840, authored by Southern California’s State Senator Sheila Kuehl (D-23). SB 840 would provide universal, comprehensive healthcare insurance to Californians while protecting consumers’ ability to choose their own doctors. Under the SB 840 model, consumers and businesses would pay an income or payroll-based premium for a “solid, comprehensive plan” that includes medical, dental, vision, prescription drug, hospitalization and emergency coverage. Medical care provision would remain as the mix of private and not-for-profit business that it is now. SB 840 would also mandate that California use its purchasing power to negotiate bulk rates for prescription drugs and medical equipment. (The administrative costs for medical care in California would drop below 5 percent of total costs, compared to the whopping 25 to 30 percent currently being spent.)

On the other side, on June 16, Sandra Shewry, Governor Schwarzenegger’s Director of the Department of Health Services hosted a meeting of journalists to discuss the possibility of “Massachusetts-style health reform” in California. As it turned out, uninvited healthcare experts and advocates showed up, as well, to deliver an early warning: Massachusetts’ so-called universal healthcare plan is already bad news for the people of Massachusetts and would be a disaster for California.

The heart of the Massachusetts plan is this: every resident of Massachusetts must have health insurance by July 1, 2007 or pay a fine–but costs of health insurance and medical care itself are not controlled, nor are there adequate standards for what health insurance is supposed to cover. Big insurance wins; consumers lose.

The Massachusetts plan offers subsidies for the very poor–as it should, and allows those who can afford it to buy insurance pre-tax–but this plan squeezes middle class people who don’t qualify for subsidies and can’t afford to buy insurance pre-tax. The plan subsidizes people who earn up to 300 percent of the poverty level. But a typical group policy in Massachusetts costs about $4,500 annually for an individual and more than $11,000 for family coverage. Many families and business would be forced to choose between complying with the law and other vital necessities. Young and healthy people might be able to buy low premium plans, but even these are now typically considered affordable only to people whose income is greater than 499 percent of the poverty level. Furthermore, such high-deductible, low-coverage plans often don’t offer even adequate coverage.

The sort of plans available to middle-class consumers–those with deductibles that run into the thousands of dollars–mean that most consumers would wind up footing the bill for most of their own yearly healthcare in addition to the premiums that such a law would force them to pay. If such consumers found themselves truly needing extensive coverage–if they get hit by a car or contract a serious illness–they may find out that their cut-rate plan will leave them in terrible financial trouble. (About half of all bankruptcies sustained in the United States today are the result of medical expenses incurred by people who had health insurance they thought they could trust). Middle class consumers will not be able to choose the doctors they most trust but will be forced to decide among the doctors whose services are covered by the plan they can afford.

The sad joke is that plans like this are being marketed as ‘consumer driven.’ Healthcare consumers (that is to say, everybody) please take note: any so-called ‘consumer-driven’ health plan is really an anti-consumer hit and run. California State Senator Sheila Kuehl is offering a real alternative. Her bold legislative initiative would bring truly affordable healthcare to all.

SB 840 has already been passed by the California State Senate and the Assembly Appropriations Committee. It will likely be up for a floor vote by the Assembly later this week or next Monday. Ask your California friends to support this bill–and to contact their Assembly representatives to vote “yes’ on SB 840. And urge your own state legislators to put forth similarly bold proposals.