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  Single Payer?
Dr. Jerry Rogan has been consulting about Medicare and medical care delivery for a variety of companies beginning 2003, having served over 100 clients, some for a short term need and some over several years.



For the past two years, the State of California has sponsored a Commission to investigate the feasibility to enacting a single payer/funding plan that will govern the medical care for all California residents. The draft version of final report has been shared with commissioners and is posted to the Healthy California for All webpage under the Key Design Considerations tab. The report will be revised and provided to commissioners a week before the final meeting on April 25, 2022.

The work of the committee was focused on one solution, a single payer plan. This is a tunnel vision approach. The committee was not asked to review other solutions to improve access, affordability and equity. Yet, the draft report details several initiatives underway to improve access, quality and coordination of care. These initiatives are evidence that a single payer/source of funding plan is not the only solution by which the goals articulated by the committee may be fulfilled. 
The draft report details that the State of California does not have jurisdiction over Medicare and ERISA plans. I do not find anything in its proposal that will benefit me or my "middle class" family. Many aspects may harm our access to medical care, such as interfering with our medical care provider, Kaiser Permanente. Any solution to improve health equity must not penalize me and my family.

I am pleased to find several panel members support my concern. I suspect Californians who are happy with their medical care plans will write to their Congressperson to block allowing California to gain control of Medicare and ERISA plans. 

Will the work of the committee be sent to the "round file"? To mitigate this risk, the committee should compile a supplemental report that lists other methods to accomplish the same goals without a single payer plan, through incremental improvements. The committee has received many suggestions which are posted on its web site.

For example, we can make medical staff peer review more effective, institutionalize root cause analysis of medical disasters, allow commercial plans to collectively negotiate drug prices, eliminate the corporate practice of medicine bar, provide an administrative process of medical negligence litigation for patients insured by public plans, address shortages in training of physicians, facilitate hospitals to develop on-the-job internships for nurse graduates. 

The deliberations of the committee is evidence our democratic republic works.

~ Gerald N. Rogan, MD
Medicare Consultant















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