We have seen several examples in other states of incremental approaches to providing universal access to health care. Is incrementalism the answer or should we look to some other model?
Dr. Joyce Lashof
I have been fighting for universal health insurance since 1948. In the 1970s, when I was health officer in Illinois, we were holding forums around the state on national health insurance. Of course, we weren’t lobbying; we were providing information and education on the need for national health insurance. We were arguing incrementalism and saying that that was not the way to go. It would take the pressure off and move the people with the least voice out of the picture, and therefore that doesn’t work. But I have to admit at a symposium that we were having on the topic, I said that up until then I had opposed incrementalism, but I would take anything that we could get – I’ll take the incremental way if that’s the way to get there.
Dr. Eugene Feingold
I share some of Dr. Lashof’s feelings. My concern about incrementalism is that it isn’t necessarily, or most likely, a way to get to our final destination of universal health care more slowly. It is a way of changing the destination. I think we have to be very careful about that. At the same time, I welcome the child health initiative, recognizing its limitations. It’s certainly a step forward.
Dr. Richard Brown
Like Dr. Feingold, I feel that incrementalism can be a diversion from our goal. I think incrementalism or, on the other hand, a strategy that says that either we get coverage for the entire population under the ideal system that we would like to see in place or we will accept nothing are strategies for defeat. I think there are strategies that allow us to see our goal and then to put in place the building blocks to reach it. Incrementalism involves building a foundation to take us on the road to where we want to go is not an incrementalistic strategy that diverts us, but helps us to get there.
Dr. Helen Rodriquez-Trias
We in public health are not prepared to advance what needs to be done, like the relationship between public health services and private managed care plans, which now serve so many populations that were formerly being served by public health. The physicians aren’t there. The research hasn’t been done. The data have not been provided. We have not been ready. Admittedly, this is a runaway train in many ways. We have to be part of what has happened because we have not been directing these market forces. They are happening and they are going to happen, with or without us. We have to be there to defend the rights of the people whom we are committed to serve. We have to be there to point out what effect managed care is having on the uninsured, whose numbers have increased in California in the past 3 years since managed care took off. We need to build in the tools of accountability and participation in planning and quality control by the people who are users of these programs.