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CaliforniaSpeaks was a statewide
nonpartisan Nonpartisan or non-partisan may refer to: __NOTOC__ General political concepts * Nonpartisanship, also known as Nonpartisanism, co-operation without reference to political parties * Non-partisan democracy, an election with no official recognition ...
deliberative forum on
health care reform Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to: * Broaden the population that receives health care coverage through either public sector ins ...
that took place on August 11, 2007. More than 2,000 Californians gathered in "town meetings" at eight locations, including
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,
Fresno Fresno (; ) is a city in the San Joaquin Valley of California, United States. It is the county seat of Fresno County, California, Fresno County and the largest city in the greater Central Valley (California), Central Valley region. It covers a ...
,
Los Angeles Los Angeles, often referred to by its initials L.A., is the List of municipalities in California, most populous city in the U.S. state of California, and the commercial, Financial District, Los Angeles, financial, and Culture of Los Angeles, ...
,
Oakland Oakland is a city in the East Bay region of the San Francisco Bay Area in the U.S. state of California. It is the county seat and most populous city in Alameda County, with a population of 440,646 in 2020. A major West Coast port, Oakland is ...
, Riverside,
Sacramento Sacramento ( or ; ; ) is the capital city of the U.S. state of California and the seat of Sacramento County. Located at the confluence of the Sacramento and American Rivers in Northern California's Sacramento Valley, Sacramento's 2020 p ...
,
San Diego San Diego ( , ) is a city on the Pacific coast of Southern California, adjacent to the Mexico–United States border. With a population of over 1.4 million, it is the List of United States cities by population, eighth-most populous city in t ...
, and
San Luis Obispo ; ; ; Chumashan languages, Chumash: ''tiłhini'') is a city and county seat of San Luis Obispo County, California, United States. Located on the Central Coast (California), Central Coast of California, San Luis Obispo is roughly halfway betwee ...
. It was organized by the nonprofit AmericaSpeaks, and was funded by The California Endowment, The California Wellness Foundation, and the Blue Shield of California Foundation. In 2007, it was described as "one of the world's biggest ever public engagement processes" by a UK public participation charity. A 2015 article in the journal ''Political Communication'' has described it as a "natural experiment" in structured deliberation. Organizers of the CaliforniaSpeaks worked with a survey research firm to randomly select demographically diverse participants who would be representative of their localities. During the event, participants were assigned to groups of 8 to 10 people with whom they discussed health care issues throughout the day, with the help of a skilled facilitator. Each participant reported their views through a keypad device, and filled out surveys before and after the session. The results of the forum were compiled into a report, which was then presented to the California legislature and governor, and subsequently influenced proposed legislation.


Background

On January 9, 2007, Republican
Governor A governor is an politician, administrative leader and head of a polity or Region#Political regions, political region, in some cases, such as governor-general, governors-general, as the head of a state's official representative. Depending on the ...
Arnold Schwarzenegger Arnold Alois Schwarzenegger (born July30, 1947) is an Austrian and American actor, businessman, former politician, and former professional bodybuilder, known for his roles in high-profile action films. Governorship of Arnold Schwarzenegger, ...
of California proposed comprehensive health insurance reform for California that would lead to nearly universal
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
coverage in the state. The $12-billion plan sought to provide medical insurance to the 5.6 million adults and quarter of a million children who did not have it. Both supporters and opponents of the plan acknowledged its audaciousness; Schwarzenegger sought to impose "new fees and obligations on doctors, hospitals, employers and insurers" to pay for it. Although the governor's plan won international praise, it failed to win support from the healthcare industry or from the business lobby. By mid-year, Democrats in the Assembly and Senate combined two measures which sought to reduce the number of Californians without insurance into a new bill which would have required California employers to spend 7.5% of payroll on health insurance for their workers. At the time, Democrats were confident that they would be able to persuade the governor to sign some form of the bill into law.


The forum


Selection process

Initially, 120,000 people were solicited to join the CaliforniaSpeaks event on August 11, 2007. In the end, there were a total of 3,500 participants in CaliforniaSpeaks, but only 60% of them were from the random selection process. The other 40% included people who were recruited by interest groups or grassroots organizations (19%), plus friends and family who came along. There were more than 440 professionals who volunteered as table facilitators on the day.


Town halls in eight cities

On the day, Governor Schwarzenegger addressed participants in Los Angeles in person, and other locations by satellite video link. The event was broadcast live on public television and via webcast. Also participating in the event were Assembly Speaker
Fabian Nuñez Fabian may refer to: People * Fabian (name), including a list of people with the given name or surname * Pope Fabian (died 250), Catholic saint * Fabian Forte (born 1943), 1950s American teen idol, singer and actor, known by the mononym Fabian * ...
and Senate President Pro Tem
Don Perata Don Richard Perata (born April 30, 1945) is a California lobbyist
and former Michael Villines Michael N. Villines (born March 30, 1967) is an American businessman and former California State Assemblyman, who served from 2004 to 2010 representing the 29th district. The 29th Assembly District includes Clovis, Fresno, Madera, Orange C ...
. During the opening session, the governor and legislators pledged to accept the recommendations made by CaliforniaSpeaks and to take action on legislation. Participants were presented with six proposed changes to healthcare. In small groups of 8 to 10 people, they discussed what they liked, their concerns, additional aspects that were not addressed, and what changes they would support. At the end of the event, AmericaSpeaks handed out postcards pre-addressed to participants' lawmakers.


Participant reactions

According to AmericaSpeaks, participants in CaliforniaSpeaks left feeling more positive about state government. They also expressed a stronger belief in their own ability to be heard, and were more likely to take political action, compared to non-attendees. Some participants questioned how the forum could have truly been neutral, if it was funded in part by foundations established by insurers. Others complained that rather than encouraging a free-ranging discussion, the choices participants were offered were restricted to those that the Schwarzenegger administration had identified as "feasible for legislative passage". Critics also expressed regret that AmericaSpeaks had not taken specific feedback onboard.


The results

Participants identified four key values to guide health care reform at the start of the forum: Health care should be affordable by all, everyone should have access, greed (profit) should not be part of the system, and wellness/prevention should be a priority. There was general support for the AB8/Governor’s range of proposals, with a number of conditions. Employer mandates were supported but most participants also wanted to assure that part-time and other employees were covered.
Individual mandate An individual mandate is a requirement by law for certain persons to purchase or otherwise obtain a good or service. United States Militia act The Militia Acts of 1792, based on the Constitution's militia clause (in addition to its affirmative ...
s were supported as long as there was an adequate standard for quality of care and other guarantees.
California Speaks, Preliminary Report, August 11, 2007
Over 80% of this cross-section of Californians expressed a willingness to “share the responsibility” for paying for expanded health insurance. Results from the discussion were compiled into a report at the end of the meeting, and were given to participants, decision-makers and the media as the meeting concluded.


The impact

The results and interpretation were presented to representatives of the California Legislature and Governor on August 23, 2007. The conclusions drawn during CaliforniaSpeaks directly influenced legislators' approach to the compromise bill which followed. The compromise bill moved closer to reflect participants' views on three-quarters of the issues that had been debated, such as the importance of prevention and wellness, and streamlining administrative procedures, as approaches to cost containment. 58% of participants had supported a cap on insurer profits, which had only been part of the governor's original proposal; this, too, was added to the final compromise bill.


See also

* AmericaSpeaks *
Medicare for All Act The Medicare for All Act (abbreviated M4A), also known as the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John ...
*
Universal health care Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized a ...


References

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External links

* http://www.californiaspeaks.org/ * https://archive.today/20130414143111/http://www.calhealthreform.org/ * https://web.archive.org/web/20071009130315/http://www.cahealthreformnow.org/
California OneCareNow Campaign

Health Care for All—California
* Video Archive of CaliforniaSpeaks (in chapters) https://web.archive.org/web/20070929103347/http://www.fc-tv.com/clients/americaspeaks/webcast/ * Video Highlights (8-min) https://web.archive.org/web/20070929103253/http://www.fc-tv.com/FCVideo/CaliforniaSpeaks/caSpeaks5minlowres.wmv Government of California Citizens' assemblies Healthcare reform in California