Associated Press

SAN FRANCISCO (AP) — Almost everyone agrees California’s health care system is hurting badly, but are enough businesses and consumers ready to accept the potentially painful cures currently in the works?

It’s a question likely to be hashed out over the next two to three years as the health care system’s deepening problems continue to affect more Californians and propel reform efforts.

“The long-term prospects for the private market aren’t good unless we make some changes,” said Bruce Bodaken, chief executive officer of Blue Shield of California, the state’s fourth-largest health maintenance organization.

Bodaken cast a spotlight on the reform movement earlier this week by announcing Blue Shield‘s support for a universal care health insurance system that would require businesses to provide coverage to all workers. The unemployed and their dependents would be covered by public insurance programs, such as Medical.

Other possible remedies include a planned ballot initiative that would give California regulators the power to control the rates of health maintenance organizations.

The initiative might be presented to voters as early as 2004, said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, the same group that overhauled California’s property insurance system when voters approved Proposition 103 in 1988.

A bill advocating a government-run “single-payer” system modeled after Canada’s system is expected to be introduced.

All of proposed reforms contain unpopular elements that will make it difficult to win approval.

Both the universal care and single-payer system would likely require tax increases.

“Clearly, universal care would require universal responsibility” for paying the bills, Bodaken said.

Setting up a regulatory system to approve HMO rate increases probably would create more government bureaucracy and threaten competition.

Bodaken and most other reform leaders doubt meaningful changes will be approved during the next year, particularly with the state’s worsening budget deficit demanding attention.

Nevertheless, the prospects for health care reform haven’t been this good since former First Lady Hillary Rodham Clinton led an ill-fated attempt to overhaul the national system a decade ago

“We have this broth that is starting to bubble up,” Court said. “This might be the first time where the insured and uninsured share the same anxiety about whether they will be able to get the kind of medical coverage that they need.”

Albino Dominguez of Alameda has been trying to cope without health insurance since his company moved to Mexico three years ago.

A 63-year-old diabetic, Dominguez, doesn’t know what he would do if he didn’t have access to a low-cost Oakland health clinic. If he had to pay full price for his twice-monthly trips to the San Antonio Neighborhood Health Center, he couldn’t afford to go.

“It’s expensive,” he said.

A backlash to the cost controls imposed by health maintenance organizations is even starting to disillusion insured Californians.

Only 58 percent of California doctors are accepting new patients covered by HMOs, according to a recent study by the University of California, San Francisco. About 18 million Californians are covered by HMOs.

Doctors’ reluctance to deal with HMOs reflects their frustration with a system that pays them more for seeing many patients quickly instead of devoting more time to providing better preventative care for fewer patients, industry observers said.

This phenomenon makes it even harder for consumers to stomach the higher premiums that are being passed on to them as insurers raise the rates that they charge employers, said Daniel Zingale, director of California’s Department of Managed Health Care.

“We are concerned that patients are getting less quality care while they are having to pay higher prices,” Zingale said.

Some of the price increases reflect a hidden tax already imposed on most consumers and businesses, said Assemblyman Keith Richman, R-Northridge. That’s because doctors and hospitals end up passing along the unpaid bills run up by estimated 6.5 million Californians without medical insurance.

As a possible remedy, Richman this week introduced a bill that that would draw on federal government subsidies to buy health insurance for more Californians.

Backed by labor unions that are making health care reform a top priority next year, State Sen. Jackie Speier also introduced a bill that would require businesses to insure all their employees.

If nothing else, Richman said the bills “are trying to educate the Legislature about the seriousness of this crisis.”

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On The Net:

Blue Shield of California: http://www.mylifepath.com

Foundation for Taxpayer and Consumer Rights: http://www.consumerwatchdog.org

California Department of Managed Health Care: http://www.hmohelp.ca.gov