California’s Separate and Unequal Healthcare System and How Sacramento May Only Be Making It Worse

New Op-Ed piece by Paul Y. Song, MD


Over the past two years, there have been countless tragic stories about the separate and unequal nature of Medi-Cal (California’s Medicaid system). These reports have highlighted numerous disadvantages, overall difficulties, financial hardships, and outrageous delays that far too many Californians and especially those from communites of color face.

Dr. Song points out how discrimination is part and parcel of the current CA Medi-Cal payout system. In addition to their goal of ridding Medi-Cal patients from their resident rosters, this is related to private operators like Pacifica Companies’ quest to eliminate bilingual and bi-cultural care for Japanese and Japanese America seniors:


California’s Medi-Cal reimbursement ranks 48th out of 50 states as per the Medicaid Fee Index and pays California physicians and hospitals half of what Medicare pays. Because payments are so low, very few doctors and hospitals serve the nearly 13 million enrolled Californians. In fact, some disadvantaged communities have ten times fewer doctors than more affluent cities. And a 2015 survey found a ratio of only 39 full-time primary care doctors per 100,000 Medi-Cal patients.

As a former oncologist, I have witnessed and participated on both sides of this unequal system. When I practiced at Cedars Sinai in Beverly Hills, I treated few, if any Medi-Cal patients. But, when I practiced at Dignity California Hospital in downtown Los Angeles, I treated mostly uninsured and Medi-Cal patients. In fact, a 2021 Lown Institute report found MLK Hospital received 75% of its total patient revenue from Medi-Cal versus 10% for Cedars Sinai. And 94% of patients treated at MLK were of color, but only 36% at Cedars Sinai.

The U.S. has now passed the 800,000 death toll due to the pandemic (worst in the world, by far, with total deaths now nearly doubling the total number of U.S. American deaths suffered during WWII). A Lancet Report to the United Nations assessed that 40% of these deaths were preventable, with most of those 40% of deaths being related to lack of adequate health insurance. It need not continue this way. A new bill is heading to the the CA Assembly floor, AB 1400 and it deserves our support.


Sacramento can do far better. AB 1400 introduced by Assemblymember Ash Kalra would establish a comprehensive state run single-payer coverage system. It would streamline payments, greatly reduce per-capita healthcare spending, obtain bulk discounts in medical good, prescription drugs, and services and use these savings to provide enhanced benefits and coverage with no co-pays or deductibles. It would eliminate Medi-Cal and provide everyone with the same equal access to high quality care. Opponents will falsely claim that we cannot afford it, but a 2016 UCLA Center for Health Policy Study showed that public funds already account for 70% of all state healthcare spending. And multiple independent analyses including a 2018 study from the conservative Mercatus Institute have all found single payer systems to save billions of dollars compared to the status quo while insuring everyone. The real question for Sacramento is can we really afford not to?!

Paul Y. Song, MD

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