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Does Everyone Have Skin In The Game?

ALPERN AT LARGE - When it comes to having all of us pull our fair share of the load, Governor Brown wants to have more of us have some skin in the game.  I really relate to that.  After all, I am a dermatologist — I really do relate to skin.

And even though Governor Brown lost his request for Health and Human Services Secretary Sebelius to allow California’s poor to contribute to their federally subsidized healthcare (link), he does have a point about allowing co-pays from federally-subsidized healthcare recipients for E.R. and doctor/dentist visits.
I treat many Medi-Cal patients, many patients with high-deductible insurance, and many patients with no insurance.  Co-payments for those who still have private insurance are going up, as are monthly premiums for patients and their employers who clearly have “skin in the game”.

But after daily bending over backwards to get quality and affordable care to my patients, it’s hard to escape the conclusion that there are two groups of “needy” patients:  one who truly are poor (and who deserve a lot better than what they’re getting) and those who claim they’re poor…but their electronic gizmos, cellphones and nice cars suggest otherwise.

In other words, some of our most needy patients might not be getting a fair shake:  cancer patients, disabled patients, the elderly and infirm, etc.  It’s no secret that illness is one of the leading—if not THE leading—cause of bankruptcy and poverty (link), and only the most callous among us would ignore the human tragedy that a sudden and unpredictable medical catastrophe can do to a person, and to his/her family.

On that note, it must be remembered that every person who is a medical dependent on the system is an individual for whom the rest of society must carry…so the determination of who must be truly carried is a fair and timely issue to address.  

Furthermore, the question of what role unemployment benefits should play in a person’s life is also fair and timely.

Ditto for the question of when a person has “the right” to retire, and on whose dime.

Are the “99ers” who used to dread and endure the shame of being on long-term unemployment benefits, but who now are more comfortable being on the public dole, in need of having more skin in the game?  Can they perform public service, jury duty, and assist in public works projects if they are unable to find work in order to continue receiving benefits?

And when does a state finally ask a person to just consider moving to another state that has more jobs?

But back to Governor Brown…and that “skin in the game thing”.  

With cities like Stockton confronting insolvency (link), and with California High Speed Rail Project costs escalating at truly high speeds (link), and the question looming of which illegal immigrants to benefit from a Dream Act (link), all sorts of issues come to mind, such as:

--Are those public sector employees who deserve a raise to blame the taxpayers, or blame those employees (and any enabling politicians) who have pilfered a pension/benefits system in ways that system was never devised to endure?  Do public sector employees (both retired and current) have enough skin in the game?

--As transparency goes up, and as the scandals keep showing up, thanks to the Internet and the empowered professional and grassroots press, do taxpayers and special interests alike have enough skin in the game?

--Do illegal immigrants, particularly adult illegal immigrants, have enough skin in the game?

--On that note, with the very top income earners paying over 50% of income taxes, do the very wealthy have enough skin in the game?  Do they have too much skin in the game?

--Should those making $2-300,000 a year be asked to have as much skin in the game as those making $1,000,000 a year?

--Is a sales tax the only way to ensure that those not paying income tax (i.e., the poor) have enough skin in the game?

And on that last note, it should be reminded that Governor Brown—who apparently wants EVERYONE to have some skin in the game—wants a COMBINED upper income tax hike AND a sales tax hike to help balance the state budget.

So when it comes to our wallets, it appears we might all get a bit more “skinny” in the game that is the Golden State’s neverending budget crisis.

(Ken Alpern is a former Boardmember of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Vice Chair of its MVCC Transportation/Infrastructure Committee. He is co-chair of the CD11 Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at He also co-chairs the grassroots Friends of the Green Line at   The views expressed in this article are solely those of Mr. Alpern.)


Vol 10  Issue 20

Pub. Mar. 9, 2012