California Lawmaker's New Plan to Reduce Healthcare Costs | Mia Bonta

California has been trying to offer health care to everybody and they've made it really affordable. You can get health insurance on their Medi-Cal, but however if you get health insurance you still don't have access to doctors and nurses because there's a big shortage of doctors and nurses here. If we actually focus on giving people an apple instead of an angioplasty, we're going to be better off. We'll be more healthy and it'll give us an opportunity to not spend so much in our health care system. The moment that I realized that if you spend one dollar on prevention it saves you ten dollars in terms of intervention and acute care really came to me when I started to look at what the average Californian is spending on their health care. Our next guest is Assembly Member Mia Bonta who's the Chair of the Health Committee in California State Assembly. She has an innovative way to deal with the health care and cut the cost. I grew up in a household where my mother worked every single day. Sometimes I would open the refrigerator and I would see celery and peanut butter and I was told that we were on a special diet and the reality was that. I'm Siamak Kourami. Welcome to Californian Insider. Mia, it's great to have you on. Welcome. Thank you so much. It's a pleasure. We want to talk to you about health care. You chair the Health Care Committee in California. One of the initiatives we want to get into the health care costs and how health care programs work but before we get into that you have introduced some programs to go after healthy living. Can you tell us what these are? It is true. I have the pleasure of being the Assembly Health Chair this year and started last year which is of great responsibility to be honest. It's one the largest policy committees in the legislature. We see over 400 bills a year and when I took on the role of Health Chair I thought about what do I want to do? What do I hope to accomplish? I decided that I want to make California the healthiest place on the planet. From that perspective it means that I'm focused on the root causes of what causes people to be unhealthy or gives them an opportunity to be healthy. Also thinking about how you create more access and affordability to health care in our systems and then how we can spend more time actually focusing on prevention and orienting our health care systems around prevention. I think Benjamin Franklin said that an ounce of prevention is worth a pound of cure and I really want to see our health policies reflect those three prerogatives to be able to have the healthiest California that we can imagine. Can you dive more deeper into what those initiatives mean? So if you look at the idea of how you go about promoting prevention, one way that we do that is by making sure that we are in an environment that allows us to be healthy and the other is to just make sure that we're treating our bodies well. One very simple thing that we can do and I've been very focused on is ensuring that we have the ability to have nutritious meals and access to food that is healthful for us. I grew up in a household where my mother worked every single day of her life as a single mom living in our household. Sometimes I would open the refrigerator and I would see celery and peanut butter and I was told that we were on a special diet. The reality was that that particular month she delayed going food shopping because she wanted to make sure that I could afford going to the dentist. That kind of growing up with the sense of the pure value of food and that there were trade-offs that one had to make in order to be able to be financially whole really stuck with me and drove this concept around making sure that we're focused on prevention and the basic necessity of food. I worked for a long time in family services and support and worked in a lot of communities that experienced food deserts. The idea that a child could be growing up without the basic nutrition that they need in order to be able to have a healthy day at school, be able to feel like they can run a mile, to be able to really kind of take in everything that they have the opportunity to have in their lives was something that really drove my early policy in the legislature. So I introduced AB 1975. It's food as medicine. I've been running it two years in a row and it's gotten far down the process but the basic idea of it is if we actually focus on giving people an apple instead of an angioplasty, we're going to be better off. We'll be more healthy and it'll give us an opportunity to not spend so much in our health care system. So there are so many things that we can do that are just basic common sense things that promote health that I think we really need to orient our health care system around. AB 1975, my food as medicine bill, is an example of that. I also ran another bill that focused on ensuring that you could have mobile farmers markets and purchases that you make from mobile farmers markets be available to people who receive WIC benefits so that you can use your WIC benefit card at a mobile farmers market, which is again this idea of let's just put food into the hands of people who most need it and everyone needs to make sure that they're starting from a place of feeling fulfilled in that way. Can you explain to us what food desert, what does that mean? I shared a little earlier that I grew up in New York City. I worked with many children in New York City and later in Connecticut who lived in housing developments where they were so isolated that they'd never been to their capital that was literally the beautiful building that we have in the state of Connecticut. They have a beautiful building too and children and families, even though it was a mile and a half away, didn't even know it existed. And so there's a part of poverty that is really focused on trying to combat isolation that is so critical and the reality is that family can have four liquor stores available to them and zero supermarkets or food markets or markets that offer fresh produce and that is a food desert where you just don't have the ability to quickly and readily access food, healthy food. You mentioned this kind of convenience stores. They are more expensive as well than the grocery stores. So we need our convenience stores. Our convenience stores are, you know, often small business owners who are largely invested in their community. Many convenience store owners live, you know, within blocks of where their actual store is. The kind of food that they have there though is, you know, they go through the process of doing their own micro-targeting and marketing to see what is more accessible. I walked into my local convenience store and I could easily get a Twinkie or a Hostess cake. I'm kind of dating myself because not many people know what those things are now these days, but I couldn't likely get a banana. And so our convenience stores really market to what they know people will decide to consume. And so it is not only about making sure that food is accessible but also creating awareness and education around the importance of nutrition to be able to support and sustain our overall health. One of the challenges is when you're living in a food desert and you are already in a zip code, if you will, where you're likely to have poor health outcomes, you are more likely to experience things like diabetes, heart disease, respiratory illness, cancer. There are already things that are going around in the environment in that particular community that also are compromising one's health. And so it's kind of a double whammy for a lot of people. Not only do they not have the quality food, they also are living in an environment that's not conducive to their ability to be healthful. And then I guess the triple whammy is that we may not necessarily have the awareness and the education around how to make sure that we are eating and behaving and operating, going for walks, making sure that we're getting the kind of exercise that we need to be able to promote healthful lives. Was there a moment that you realized this? A moment that I? Yeah, that there's a connection to eating healthy and we're spending all this money on health care, but we're not spending the resources there. Yeah, I think I instinctively knew it kind of growing up that we were imbalanced in that way because a lot of the diseases that I mentioned were very present in my family. I have grandmothers who passed away from cancer. I have a grandmother who had diabetes, like it's just those kind of acute illnesses and disorders have been very present in my own family experience. So I certainly kind of pull from my own lived experience when I think about policy. But the moment that I realized that this very simple thing of if you spend $1 on prevention, it saves you $10 in terms of intervention and acute care really came to me when I started to look at California's budget and how much we actually spend on health care. And I started to look at what the average Californian is spending on their health care. And I also recognized and learned that we are all living, most of us have a lot of medical debt as well. In the nation, we have over $88 billion of medical debt, which is staggering and is something that really makes it impossible for us to make sure that we're providing the kind of health care system that doesn't require us to fall into debt in order to be able to be healthy. And this debt is on consumers, individuals? Individual consumers are suffering under the weight of medical debt. It is one of the most crushing things to think that I could, in order to be healthy, I have to take on this debt that, quite frankly, makes us unhealthy from a financial standpoint and from a sense of overall well-being. So you mentioned there's $88 billion of medical debt. Are some people out there afraid of going to the doctor, going to the health care system because of the cost? Absolutely. Like if you just think about human behavior. So I am feeling sick today. I have a fever and I know I should go to the doctor. But I know that if I go to the doctor, it might cost me, if I'm lucky, $35 for a copay to have a clinical visit. If I'm unlucky and I don't have insurance, it could cost me $350 to be able to see that doctor. And so what am I going to do? I'm probably just going to go to the drugstore, pop a couple of Advil and hope for the best. And that's on the easier side of things. We see a lot of deferred care in terms of the decisions that people make because they know that it's going to be so incredibly expensive. I just was talking to a bunch of dentists, for instance. That's health care. How many times do we make a decision to forego getting that cavity filled because we know it's going to be too expensive? And then what happens to that cavity? It turns into a root canal. You know what happens when you have a root canal? You can literally have infection that goes into your blood system. So there are dire consequences to pushing off the basic things that we can do. And one of the root causes of that is that it's just too expensive for people to wrap their brains around making a choice to do that instead of something else that they absolutely need. And the average person is living with the weight of being financially burdened from not being able to have a healthy life and access to preventative care. That is in the exploration of both food as medicine and some of our early policies in this area. I start to look at what it would mean if we just refocused on prevention instead of acute care and intervention. You have introduced this bill, this concept. Did it get much traction within the capital and within the community? So every piece of legislation I call just a process of iterating towards the common good. And in this case with a bill like food as medicine, that was something that came from my own experience of, as I've shared before, and meeting with advocates who wanted to make sure that we focused on providing this kind of support to be able to offer a different benefit through Medi-Cal for preventative food and nutritional services. So a lot of advocates signed on to that, people who were involved in the food justice space. I represent the Bay Area and we are rich with advocates and providers who just carry the legacy of really caring holistically about our community. And the Bay Area is not that far from here in Sacramento, so they're often up here in the capital and visiting with us and putting really great policy ideas on the table for us to consider. So my first step was to really convene with the advocates and put together a plan that we thought might work. And then I had to walk it around to our other legislators. And the reality is that every legislator that I talked to was able to tell a very similar story, either from having an experience around food insecurity themselves, or having someone in their lives that were experiencing a major illness, whether it be cancer or even asthma, or things that just kind of compromise their overall health and well-being. And everyone can point to somebody who they wish was more healthy in their lives. And so my fellow legislators were a pretty easy sell, if you will, because they were also bought into and aligned with this idea of making sure that we could all be healthy from a food perspective. And the challenge then comes when you're kind of talking to some of the agencies like the Department of Public Health or the health agencies that are looking more at the finances associated with a proposal like the one that I put And that's where the conversation more moves into, I would say, kind of trade-offs. Like if we decide to move forward with providing this benefit around food as medicine, what does that mean that we can't do from another perspective? And those are where we kind of run into some challenges. And those conversations happen in appropriations. We got through appropriations in both times that we moved forward with the bill, and it got all the way to the governor's desk. It was actually a part of a broader package for a couple of different caucuses that I was in. And it got to the governor's desk, and he decided to veto it. However, he did give me one of the kindest veto messages that I've ever gotten, or probably will ever. And it basically said, I believe, and I hold the value, that it's really important to focus on prevention. And I think that we can do this through the budget. And let's really focus on figuring out how to move this forward through the budget process. And so this year, we will focus on trying to move the same bill and the concept through the budget process. Now, is there a big cost to this? So you mentioned trade-offs. Is there a big cost to this? And what are the trade-offs? So I think the legislation that we put forward got tagged with a fiscal of about $80 million a year. That's a significant cost. We always have to pay attention to the costs. One of the things that I really hope that we do, especially if we're orienting ourselves around prevention, is that we more focus on the opportunity costs of not doing something. And so while within one budget year, this piece of legislation could cost us $80 million, on the other hand, we know that over the course of 10 years, it would save us $800 million a year if we actually focused on prevention. So one of the challenges, I think, with legislating and governing is that we think in terms of budget years, one year at a time. That's the increment of change and analysis that we need to apply. And for some of the initiatives that we focus on, it makes more sense to think in terms of opportunity costs. What does it cost to not do something? Because that could be far greater in dollars and cents. Forget in terms of the value of human life and the human side of it. That's where I'm hoping that we can develop in our budget process and in our legislative process as well. So would that cover all of California or would it be a much higher cost to cover all of California? No, that is for the entirety of Californians who are on Medi-Cal. That particular bill that I was talking about is targeted for people who are on Medi-Cal and providing them with the additional benefit of being able to receive food service plans or meal plans or basically a prescription for good food. Healthy food. Yeah, for good food. What about the rest of California, people that are not on Medi-Cal? Is there any thoughts on working on the healthier California? On a healthier California in that way, absolutely. So part of what I started out with was saying the way that we get to a healthier California is also looking at some of the root causes associated with our environment. I represent Oakland, live in the little city in Alameda next to it. And on one school day last year, very early in the school year, we all woke up to a plume of smoke. The sky was orange. I found it hard to breathe. I was probably about two miles as the crow flies away from the cause of that fire, which was a metal shredding facility that had had something catch on fire inside their facility that caused there to be smoke in the air that went for miles, essentially. Within the range of that metal shredding facility, there are 18 preschools, eight schools, two hospitals, a handful of elder care centers. And that is the life of anyone who lives in West Oakland where this metal shredding facility has to deal with. In the last five years, that metal shredding facility has had five fires that have caused that level of toxicity and air pollution. So for all Californians, the reality is that air pollution is known to shave off years of our life. In fact, I think 29% of people who experience lung disease is caused by the root cause of air pollution. And so all Californians are dealing with the reality that we have pollutants that are making it hard for us to breathe. In this instance, just another bill that really applies to all Californians, one of the things that we wanted to do was hold metal shredding facilities accountable by doing a very simple thing, which was just tell us, just give us notice if there is that kind of accident in your facility through the industrial activities that you are performing, that we have the ability in the state of California to have a fence line monitor around that space that will provide notice for the people who are living in proximity to that industrial activity so that we don't accidentally go out and see the sky is orange and just assume that it's okay to be out there. There are a lot of things that we can do for everyday Californians to promote health. One is just recognizing that our air pollution has an impact on our overall respiratory healthfulness. The other is to just build awareness around the importance of nutrition and access to food for everybody and just to make sure that we're providing as much opportunity for us to live healthy lives. And in terms of on the other side of it, when it comes to the health care, the state is facing some challenges with nurse shortages, right? And health care. Oh, absolutely. Yes. So again, how do we get healthy California? Make sure that we have access to affordable, high quality health care. At the center of that is the nurse, the doctor, the lab technician that we need in order to be able to provide that care for us. And in California, we are experiencing shortages in a lot of those areas and also a challenge with making sure that our health care providers actually look like and have the kind of experience that their patients do. And that's another critical piece of this. So California is an amazing state. We have one of the best public higher education systems in the world with our community college systems, our CSUs, our UC system. And one thing that we can absolutely do is make sure that we're creating very strong pipelines that will generate filling all these jobs needs that we have in for health care technicians, for nurses, for doctors, for dentists, for mental health care providers, which is also a huge need that we have right now. And for that, we just really need to focus on, I say, connecting the dots. And what I mean by that is I want a sixth grader or an eighth grader as I was to be able to take a class and have something spark in their brain that says, hey, I could be a doctor. I could be an x-ray technician. I can be a phlebotomist. I can do all these things that contribute to our overall health and also is a job that will provide me with a thriving wage. And we have all of the ability to be able to have that eighth grader have that idea because they have the experience in their curriculum and in their schooling. And then they have the ability to just look a little ahead and know that they can enter into a vocational program or into a two-year college or a four-year college where they can get certified to be able to be a health care worker or go beyond that to graduate school and become our best doctors and surgeons of the world or health care administrators. And we can make sure that California is growing its own and feeding the health care pipeline that we so desperately need. But it's a really critical need right now. So we have primary doctor shortage. Do you think it's that people don't want to be doctors or is it that this education system doesn't exist and there's not enough availability, especially for nurses? We've heard that there's limited programs and people. That is true. I think it's a couple factors for me. One is that we don't have enough programs where people want to go to school. I think you mentioned that you might be heading out to Fresno or Bakersfield kind of in Central Valley. I worked with another assembly member, Esmeralda Soria, who is in the Central Valley and she promoted a bill that would ensure that we had ability to expand our nursing programs into community colleges, which is something that is very critical because she knows what I know, which is that if I'm a 16, 17-year-old and I am really in love with, because there are these 16, 17-year-olds who are so in love with their families that they don't want to leave them, and I just want to stay close to home and I want to continue to be able to contribute to my community, I want to go to school in my community to be able to get the qualifications that I need to become a nurse. That should be something that we are able to provide. So I do think that part of the challenge is that we need to make sure that our schooling pods and where we're actually providing those kinds of qualifications and opportunities are close to the communities that are experiencing greater need for any particular position. I think the other issue, just quite frankly, is that going to school still, even in California, for higher education is a very expensive proposition and I feel like there are a lot of youth who are coming up right now who are looking at college, their post-secondary life, and don't want to take on $150,000 of debt, by the way, which is what I graduated with, and had to pay off forever in order to be able to get a job that they love. And they're making different decisions in terms of the math on whether or not it makes sense to do that. And unfortunately, some of them are deciding that it doesn't really make sense to do that. And that's costing us people from being able to enter into the healthcare profession or into our higher education institutions. And so one of the things we absolutely have to work on is lowering the cost of education. So it's not the willingness, people want to have these jobs, it's just the cost. I had the privilege of going into a lot of different classrooms, elementary schoolers, 11th graders, and if I walked into any classroom and I asked people to raise their hand and say, what do you want to be when you grow up? Do you want to be a nurse or do you want to be a doctor? Half of the room would raise their hand. So it's really not an issue of will or vision or recognizing that those are noble positions and professions that help their family members and help their community. They have the vision around that. We just need to help to make sure that they can hold that vision as they go on in their educational experience. We are honored to be sponsored by Shen Yun. I've been attending Shen Yun performances every year as they change the choreography and music. Shen Yun takes you back in time to the magical world of ancient China with unique blend of brilliant dancing, beautiful costumes, and legends coming to life. Overall, it's a very meaningful performance with a lot more than just entertainment to offer. Make sure to go see it this year. Go to ShenYun.com and book your tickets today. I highly recommend it. People nowadays go to the doctors, the psychiatrists for pills, for antidepressants. This, this is the antidepressant. The best. I knew it was going to be good. It's a billion times better than I even thought it would be. I've heard people say, you don't want to miss this. And I would fully agree. I'm going to tell everyone to come see it. You have to. Definitely going to come back next year. Totally inspirational. You have to go see this. It's a once in a lifetime must see that will change their lives forever. So if we were to ask you for Californians, five years from now, you will have a vision to make California healthy. Where do you think we would be? How do we get California to be the healthiest place on the planet? Let's see. Well, I think we've talked about a few of those things. One is to just make sure that we are creating a really robust pipeline of health care providers, particularly in mental health. It's one of the areas where we just haven't invested, historically have not invested enough. We're starting to now. So one thing five years from now is that we would have a pipeline very clearly laid out, which would have tens of thousands of people entering into the health care profession from all walks of life. I think the other piece would be that we kind of hold on to and recognize that your zip code matters, unfortunately, and health disparities are something that exist because of where you live. And we would be on a path to making that not the case, that your zip code doesn't predict whether or not you will live seven years more than somebody else who lives in a different zip code or less. And so five years from now, we would be well on a path towards a public health program that is cognizant of the impacts of our environment. That would be a pretty critical piece of of what the next five years would look like and that health care would be affordable and accessible for all. I guess the caveat for me is on our terms. I want to be able to go to the doctor and know that I don't have to wait five weeks to go see a doctor for that doctor to then tell me that I need to wait another two weeks to get to a specialist. That piece won't be done in five years, but it is a piece that I'm definitely committed to as health care to just make sure that we are promoting accessible, affordable, centered around the human and the individual in terms of the experiences that we should have in order to be able to access the care that we need to live our beautiful lives. In this process of you getting involved and you're thinking outside of the box, the health care, are you facing any challenges from the traditional health care providers that are looking at this and saying this is working for us? Well, we're in my office. No one who comes into my office says our health care system is working perfectly. Please don't change anything about it. I think everybody recognizes that there are aspects of our health care system that need to be changed. It's always about perspective and kind of are you somebody who's with the health plan? Are you a health care provider? Are you an advocate? Are you just Joe trying to get good health care? All of those voices will come into our capital and walk these halls with their truths and their reality around what needs to change. And I think the beauty and the challenge of being the health chair right now is that I get to listen to all those voices and try to weave them together to be able to put forward a plan and a set of policies with my colleagues that are going to help us be stronger. Mia, you have had a long career in public service. Can you tell us how you got into it? So I was born and raised in New York City. My mother, working mom, amazing woman. She had the good sense and foresight to send me to a very special school in New York City that was a Quaker school. It's called Friend Seminary. And I grew up going to that school from fourth grade to when I graduated high school with this ideal of that you connect to your faith through service. That's really how my life of service really was born. Having incredible role models who believed in our country, who believed in individual and the common good, and also just being a part of a schooling community that valued more than anything else this idea that we could be the best of ourselves when we are being of service to others and had the opportunity to just have my own clarity at a very young age because I was the beneficiary of going to this very unique school. But I was traveling an hour and a half to get to that very unique school growing up as a kid in the Bronx. And my neighborhood was a very different reality from the neighborhood that I was going to school in every single day. So every day, I lived this life of understanding what it meant to have privilege and what it meant to not have that privilege. When I was 13 years old, I took a class in psychology and just got hooked on this idea of human development and the idea that how we are brought up into this world and how we respond to that world fundamentally impacts whether or not we are going to be able to thrive. And the same year, no joke, I also took a class that focused on the idea of the importance of education. Learned about John Dewey and the idea that the way that we secure our democracy, small d democracy, is by making sure that we all have the ability to engage in civic discourse and that we are educated and have the ability to really do so in a way that doesn't tear everyone down, but really looks to be able to really understand why somebody has a strongly held belief. I think those two influences early on in my own educational experience got me very, very focused on the idea of education being a pathway to not only me being able to contribute to my community, but also education being the way that our community could be whole. And so I went to college. My first job out of college was working with children seven years old to 24 years old, elementary to college students who were basically in this experiment of how can we support our community and our neighborhoods by supporting each other. That was in Connecticut and just went on for many years to just invest in nonprofit organizations, primarily in education and family supports. Went to law school, got the bug around just making sure that we were protecting our individual civil liberties, if you will, and then tried to find a place to do education and do law. Came up short for a little while, but always focused on just being of service and got to come out from New York City and Connecticut, East Coast to California and worked in philanthropy for a while. So helped to just make sure other nonprofits were having the resources that they needed to do to support their own mission. Started my own nonprofit and did some work there for a while and then ran for school board and was on school board and had an opportunity to run for assembly and it was a special election, a rough and tumble election and ended up in office in the assembly in 2021 where I've been. And how is it? This is, being a part of the state legislature in the state of California, the fifth largest economy in the world, with all of the resources to be able to do good, for me is really a dream. It's just something where I could have spent the entirety of my life in doing public service and nonprofit work, kind of dealing with the current problem that was in my face at the time in terms of somebody who was of need and suffering. And I was incredibly fulfilled doing that work. And also at the same time, always a little frustrated because I knew that there were other, you know, there were powers that be that were impacting the reality for members of my community. And being in the legislature, I get to really be able to take all that experience and put forward policies that operate at scale and have the potential to have impact, not only for the people that were kind of with me every single day that I was concerned about, but over the course of time. So these position that I was fortunate enough to get elected to serve in is just, I treat it with the deference and the respect that it deserves. And I'm very thankful that I get to do it. And it's hard. What part is hard? I have to spend a lot of time just being pretty vulnerable about my point of views and standing up for what I believe is right. And kind of when you put yourself out there, there's always an opportunity for people to look at that and look at you and make comment on it. And so sometimes those comments are a little harsh and that part's not so fun. Is it from the public or is it from the legislature? Oh, never the legislature. It's the public. Yeah. Sections. I don't even know. I think it's from bots, to be honest with you. Now, your philosophy of service, your mother decided to put you in that school. Where does it come from? Does it come from your mother or does it come from the school? And can you go in deeper into that? Oh, my philosophy of service is really just a combination of recognizing at an early age that I was given something that members of my community did not. I talked about that travel an hour and a half back on the train when I was nine years old. I had a best friend named Tina. The sun rose and set on her face. And it was so incredibly important for me to know that Tina was OK in this world. I went on to go to this very special school. Tina went on to go to our neighborhood school and Tina ended up pregnant at 14 in a relationship that was not positive. And with a very, very hard life before her, I ended up having an opportunity to go to Yale. I think the awareness around the fact that the opportunities that you are presented with can lead to vastly different outcomes was something that I kind of knew from very early on. And I think that that has kind of shaped my drive to just always make sure that I'm providing as much opportunity for others so that they have a chance at being their best selves in their lives. Now, do you think the kind of opportunity you had right now exists for everyone in California if they want to capture it? I don't think so. I don't think that we are a society right now that ensures that every individual has what they need in order to be able to thrive. I think that the opportunity before us, opportunity for our leaders, our community leaders, our leaders in government, our leaders in faith institutions, is to pull us all together and to declare that we all have a shared responsibility for making sure that we can all have that opportunity. So while the data would support that not everyone has that opportunity, the reality of what we see with our eyes when we walk down the street certainly helps us know that. And those are the reminders of the challenge that we have, as well as the incredible responsibility that we have. So while we don't have that right now for everyone, I am an incredibly hopeful person and believe that we, from wherever we are in whatever position we hold, we have a commitment and a belief that we have a shared responsibility for making sure that that's possible for everyone. Assemblymember Miyawanta, it was great to have you on California Insider. Thank you so much. It was a pleasure to be with you. Thank you.