Californians Voice Concerns About Care

CALIFORNIA'S elderly are giving President Clinton's health-care plan mixed reviews.

Like other Cabinet members who have fanned out across America to help explain and defend the plan, Secretary of Health and Human Services Donna Shalala got an earful here last week. In the state where twice the national average of citizens are enrolled in managed health plans, the questions got hot and heavy, and answers received both applause and boos.

``I am impressed with their determination to get something better than what we have now,'' said Dorothy Mlodinoff, a retiree and member of one host group, Seniors for Action. ``But I don't think the administration has thought this all the way through.''

Out on the gym floor of a local community center, four rows of folding chairs were warmed by fidgeting citizens. Ms. Shalala worked the standing-room-only crowds with a microphone for 40 minutes before jetting on to Portland, Ore.

``Will I be able to choose which plan I get and which doctor treats me?'' asked one man, echoing perhaps the main concern of elderly citizens here.

``The whole idea is to give people information and choice,'' Shalala answered to welcoming cheers. ``Let the marketplace squeeze out the fat that years of regulation and fee structures couldn't.''

Another dominant concern here was why the administration does not support a ``single payer'' plan proposed by some congressional Democrats that would extend Medicare-type coverage to all Americans. A show of hands revealed a majority here favored such a plan.

``There isn't a lot of support in Washington right now for the single-payer system,'' Shalala said. ``There's a lack of confidence in the ability of the government to run a huge, national, socialized medical system.''

THE system California has now is already much closer to what President Clinton wants than the rest of the nation. One-third of the population is enrolled in health maintenance organizations (HMOs), compared with a national average of about 16 percent. And 75 percent of Californians who have health insurance take it in some form of managed plan.

The state has long been a leader in managed health care nationwide, beginning with the first HMO in the nation (Ross-Loos Clinic, set up in 1929). Kaiser Permanente, founded here during World War II, now provides about 20 percent of insured health care in the state.

Still concerns about the Clinton plan abound. A thorny issue raised here is how California will pay for an estimated 3 million illegal immigrants - half the national total. Though $1 billion has been set aside nationwide, state officials estimate California alone will spend more than that this year.

There is also some concern about heavy employer mandates in the plan. Gov. Pete Wilson (R) argues such costs would escalate a business exodus already plaguing the state during a recession.

For now, such queries have focused attention on a new conference committee in the state Legislature that will begin hearings next month. Its intent is to draft legislation that could consolidate the several state health-care programs.

``California has a long history of taking a great deal of time to work through complicated issues such as these,'' says Assemblyman Burt Margolin (D) of Los Angeles, co-chairman of the committee. ``If we delay in this case, we will lose access to significant amounts of federal funding.''