My emphasis. I'm lucky enough to get health care through Kaiser and I think they should be a model for the future provision of health care.
Their doctors are salaried employees, not entrepreneurs (mostly); their medical records are fully computerized; their lab and other diagnostic facilities are integrated on site; and they make their (non-profit) profits by keeping you well, not selling you more and more care. It's a great system, especially if your ailments are readily diagnosed and amenable to clearly defined treatment. They don't always do so well with the obscure and chronic complaints. You have to be able to navigate their irritating, though multilingual, voice mail system. Occasionally they screw up completely.
But Pearl is right: the rest of U.S. health care could learn a lot from Kaiser.
As I've written before, California is what you get when the Tea Party shapes government. I don't mean we elect a lot of them -- in fact we don't elect any at the state level, though some localities donate the likes of Darrell Issa and Dan Lungren to Congress. But racial and social change brought out the same aggressive attack on democracy here a couple of decades ago and broke the structure of government. For fear of the expanding brown hordes, California voters restricted the state government's power to tax and legislate; we can no longer get anything done by majority vote, so a dwindling minority of Republicans can block budgets and much forward-looking law making.
With this in mind, I was a little horrified to see that the "most emailed" story in the NYT the next day was this rather inflammatory rendering of census results:
Note he means that no demographic group will be an absolute majority; we'll all belong to racial groups that amount to less than 50 percent of the population.
If people in the rest of the country will simply look at California, they can get a preview of where this is going. If it goes down as it has here, those older whites who are afraid of the change will fight fiercely to create structural obstacles to a new and different majority asserting itself. These obstacles are likely to include attacks on education funding and all social supports for families. (See also Congressman Ryan's famous "budget" for trashing the social safety net and pampering the rich.) The panic turns into an assault on the very idea of a well-functioning government.
But the process of demographic change is not going to be arrested, no matter what fearful people manage to legislate. The transition from a majority white nation to one with no racial majority is inevitable. So the project for people who want a democracy with a more humane social system is to fight off the worst that fearful people can do now and to build for the inevitable coalitions that will create better majorities in the future.
We haven't completed the transition through the years of demographic fear here in California, but we're well on our way. While Democrats crashed everywhere else in the country in 2010, here Democrats, in their very incomplete and compromised way, embody the coming coalition with no majority. There is no reason the rest of the country can't weather the same transition.
The lesson from California is to know that the present moment is about minimizing the damage the greedy and fearful do to democracy during the transition. In the 1990s, it looked as if this might go on for 40 years. But the California experience says the current political shape of transition only lasts about a generation. There's hope out here, though we're left with massive residual dysfunction in the state government.