This is the second one of the CHIRA series (CHIRA – Part II) referencing my response to a letter from California State Senator Jeff Denham, which indicates that State legislative leaders (or their staff) are not necessarily aware of pertinent information, and certainly the general population generally are even less well informed if they do not take the effort to investigate the issue fully.

For Californians, this is the year to make a difference by letting your legislators know how you feel.  For non-Californians, you may want to pass information along to your friends in California, and maybe you can use some of the ideas in your own state.

I have no belief that we will ever have a rational National Health Plan because of the corruption of our federal government (the other subject of this web log 🙂, but we may get enough states headed in the right direction to have a very positive effect.

Thank you.
—–Original Message—–
 Sent: Wednesday, May 25, 2005 9:50 AM
To: Senator Denham
Subject: RE: Senate Bill 840
Senator Denham:
I appreciate your response to my letter, although I deeply disagree with your position on SB 840.  There is no other rational approach to eliminating unnecessary costs, duplicated and wasteful public and private sector bureaucracies and medical care rationed according to the vagaries of employment, insurability and economic status. A “massive new state bureaucracy” would not be necessary.  The current taxes and insurance premiums are more than sufficient to provide better administration and medical coverage.  I speak from over 30 years of experience working within the health care industry and from the personal experience of having to pay over $1700 a month to a for-profit insuror for high deductible medical insurance coverage for me and my wife.
The general population has not sufficiently investigated this approach to health care delivery and, unfortunately, it is difficult to break through the vast amount of misinformation that is spread about a universal coverage single payer system.  Were they to truly evaluate the facts, there would be overwhelming support for this delivery system. 
I sincerely hope that you will look in more detail at SB 840 and revise your position on its value to California and, as a model, to the rest of the nation. I am forwarding for your consideration a link to a Medscape editoral site with my published comments on SB 840:   The letter is one of those published in response to Dr. Lundberg’s editorial on health system reform.   
Thank you.
—–Original Message—–
From: Senator Denham [mailto:Senator.Denham@SEN.CA.GOV]
Sent: Tuesday, May 24, 2005 3:52 PM
Subject: RE: Senate Bill 840
Thank you for your letter regarding Senate Bill 840, relating to Universal Health Care for the State of California.  I appreciate the opportunity to respond to your concerns.
I understand your concerns regarding the issue of health care access, however, I do not believe a universal health system is the answer.  The cost of setting up a massive new state bureaucracy to run a state universal health care system would be prohibitive, particularly given the state’s current fiscal situation. It would undoubtedly force new or increased taxes on Californians.  Additionally, there are serious questions concerns about the impacts such a system would have on the quality and delivery of health care services.
The voters spoke to the issue of government-mandated healthcare coverage when they defeated Proposition 72 in the November 2004 election.  It was clear that the majority of Californians did not support a healthcare system that would fundamentally restructure healthcare in California and result in broad social and economic changes.
These issues come up regularly, and I will keep your views in mind when approaching such matters.  Please know that I support fiscally responsible programs that aim to improve health coverage for California’s residents.
Again, thank you for taking the time to share your concerns with me.  While we may not agree on this particular issue, I am sure there are many others we do agree on.  Should you need any information or assistance in the future, please do not hesitate to contact me.
Senator, 12th District

CHIRA – Part I

For the sake of simplicity, I’m going to submit two email excerpts relating to the subject of SB 840, the California Health Insurance Reliability Act (CHIRA).  The first one (CHIRA – Part I) is below. The second one (CHIRA – Part II) references my response to a letter from State Senator Jeff Denham, which indicates that State legislative leaders (or their staff) are not necessarily aware of pertinent information, and certainly the general population could be even less well informed if they do not take the effort to investigate the issue fully.
My original letter to the editor was at the request and approval of George Lundberg, M.D., Editor-in-Chief of MedGenMed (Medscape LLC) and Adjunct Professor of Health Policy, Harvard School of Public Health, Boston, MA.
Dr. Lundberg:
Regarding the judging of proposals for true health system reform based on your 11 evaluation characteristics, (“American Health “System” Reform – Part 6” )[1] , a model proposed for California should be put to the test of those elements. 
Senator Sheila Kuehl, Dem-Santa Monica, has authored SB 840, the California Health Insurance Reliability Act (CHIRA)[2].  This measure deserves to be reviewed and discussed beyond the State’s borders as its success in the world’s sixth largest economy would signal a shift in healthcare delivery systems toward fiscally sound, comprehensive, affordable and consistent health insurance coverage. 
So, based on my attempt at applying your evaluation elements, let’s see how this program might measure up compared to your grade of the 2005 American system of 52 and my grade of the current American system.
1. Access for all to basic care:  CHIRA eligibility is based on residency, not on employment, income or insurability.  All residents will have coverage of all care prescribed by a patient’s health care provider that meets accepted standards of care and practice.           
CHIRA Score:            9                      Current system score:            5
2. Produce real cost control: The plan not only involves no new spending on health care, this measure will make the health care system more reliable and secure by stabilizing the growth in health spending; linking spending increases to the state GDP, population growth, employment rates and other relevant demographic indicators.           Administrative costs will be capped by statute.
CHIRA Score:            9                      Current system score:            5
3. Promote continuing quality: “Quality” is an elusive characteristic.  Current systems attempt to fill the quality measure gap, but I believe that the best measure of quality is when consumers vote with their feet, given the opportunity to do so.  In CHIRA, providers will be free to apply their medical training and skills and patients can choose their providers based on their perception of those providers’ quality of care.  Also, the plan will invest in statewide medical databases to assist in improving health care quality and in creating programs to encourage personal responsibility for good health.  However, even a program like CHIRA can’t effect this change completely on its own. Consumers still must choose healthy lifestyles, including educating themselves and adopting appropriate nutrition and exercise programs.
CHIRA Score:            6                      Current system score:            4
4. Reduce administrative hassle and cost: Providers and consumers will not have to deal with the maze of confusing health care delivery system bureaucracies. The estimate of the current system is that half of every dollar spent on health care is squandered on clinical and administrative waste, insurance company profits and overpriced pharmaceuticals. The CHIRA model is based on independent studies showing estimated savings of about $20 billion through reduced administrative costs in the first year alone.  Analyses also show estimates through system wide bulk purchasing of $5.2 billion in the first year.    

CHIRA Score:            9                      Current system score:            4
5. Enhance disease prevention: The plan will combine needed cost controls with medical standards that use the best available medical science and place an emphasis on preventative and primary care to improve California’s overall health in a way that also saves billions of dollars. CHIRA gets an A for Effort, but; again, an educated, motivated and involved consumer is essential to disease prevention.
CHIRA Score:            7                      Current system score:            4
6. Encourage primary care: With some limited exceptions, consumers will be required to select a personal primary care physician.    Access to primary care providers could save $3.5 – $6 billion in unnecessary emergency room visits and preventable hospitalizations.
CHIRA Score:            9                      Current system score:            4
7. Consider long term care: Considerable expert analysis on Long Term Care is included in the development of the plan.  Beyond the 100 days of skilled nursing facility care post hospitalization, it is not a part in the initial benefits; but it is planned for subsequent inclusion with further review and incorporation of appropriate guidelines.        
CHIRA Score:            2                      Current system score:            1
8. Retain patient autonomy: All licensed providers and accredited facilities may participate.  Every Californian will have the right to choose his or her own personal primary care physician.  Some limited continuing service arrangements will be allowed for patients under specialist care initially, but generally a referral for specialist visits will be required from a consumer’s primary care physician or emergency physician.
CHIRA Score:            7                      Current system score:            5
9. Retain physician autonomy: Physician freedom from the profit-driven motives of most managed care plans is a major feature of the plan.  It will put medical decision-making back in the hands of medical professionals and their patients. Overall governance will be from an elected Commissioner and the State Health Agency which, while having physician and other health care provider representation, will have boards that include others, such as members of the public, consumer advocates, policy experts, and labor leadership.
CHIRA Score:            8                      Current system score:            6
10. Limit professional liability: The information system enhancements, inherent controls and quality improvement measures of the plan will present a foundation for malpractice premium stabilization and reduction.  Any specific malpractice reform would be a separate issue.
CHIRA Score:            6                      Current system score:            4
11. Possess staying power: A plan such as CHIRA has the balance of incentives and controls necessary to maintain the stability and assurance of consistent health insurance delivery over long periods of time with fluctuating personal, societal and economic conditions.  It has the mechanisms to account for the inevitable changes that will arise in health care delivery operations and technology.
CHIRA Score:            9                      Current system score:            6
CHIRA Points:             81                     Current system points:            48
Well, as you say, no reformed health care system can be perfect nor satisfy all the constituencies.  But CHIRA could be on the right track as a model plan for assuring and stabilizing health insurance coverage for a large and diverse population base.
Thank you,

Joe Polaschek


1.   Lundberg GD. The American Healthcare “System” in 2005 – Part 6; How to Grade the Current System and Proposed Reforms. Medscape General Medicine. Posted 3/11/2005.  Available at:
2.  (Link to the full text of SB 840, the California Health Insurance Reliability Act)  


Please read the editor profile, guidelines and disclaimer and objective for this web log by clicking on these sections under “Pages” on the right side.  I encourage you to check out the web site with information on John Perkins, author of “Confessions of an Economic Hit Man.”  His guidance in the epilogue of that book, that we can change our situation with “words,” was the inspiration for this web log site.

Note: Some of you will have read the following material in one of my emails, so you can “speed read” through it or just ignore it 🙂


Recent opinions regarding the president’s power in reference to protecting national security are split, primarily because few people understand the workings of government, our numerous agencies and the administration in particular.
Some key things to remember: the attacks on Americans at home and abroad are based on U.S. policies going back many years, particularly our need for control in the oil rich Mid-East and South America, our ignorance of human cultures, our arrogance in thinking that we have the “right” cause, “God is on our side,” etc.; and a thought process that war rather than diplomacy and tact is the approach to solving problems.
George Bush has bad advisors, for sure; but he also closes the doors to information that would be helpful to decision-making and uses events for his best interests and those of his cronies, his “base of support.”  The 9/11 attack was used to bring the country together, for a short time, in a common cause against a common, albeit, foggy enemy, “terrorism,” which would not be a problem if we would change our global policies.   The war on Iraq was completely unnecessary, brought the deaths of thousands of innocent people, and has made our situation less safe than before 9/11.  Bush became the “poster-boy” for Al-Qaida recruiters.  Our troops should never have been required in Iraq and when they were brought in, they were ill-equipped and insufficient in numbers.  They are there because of deceit.  They must get out of Iraq; but now in order to cover for our error, their return must be tempered by the needs of the situation.

We do not need a president and national leadership team who put personal interests above those of our country. Reviewing the political history of the United States, we know that our current administration does not stand alone in its arrogance, greed and ignorance.  But we can hope that the situation will inevitably be seen clearly by an independent media and an educated, enlightened population, and that our leadership will soon revert to someone with intelligence, courage, common sense, responsibility, honesty and integrity -  qualities that will once again elevate America to a position of honor at home and in the world.
The full solution would be for our country to eliminate a two-party controlled system and become an actual democracy in which anyone, regardless of wealth and “connections” could rise to become our leader.  How that would happen is a puzzle to me.  Perhaps we need a version of “American President” in the format of “American Idol” to develop some qualified candidates for whom we all would feel good about voting.