www.montereycountynow.com APRIL 24-30, 2025 MONTEREY COUNTY WEEKLY 19 Here’s something most of us can agree on: The health care system in America is broken. It’s too expensive; there’s a shortage of doctors, particularly primary care providers; government insurance—primarily Medicare and Medicaid—doesn’t reimburse practitioners at a high enough rate, leaving them overly reliant on commercial insurance companies. Into this web of problems, California has added oversight. In 2022, the state’s Office of Health Care Affordability was created, and its board convened for the first time in March 2023. Per statute, “The office shall be responsible for analyzing the health care market for cost trends and drivers of spending, developing data-informed policies for lowering health care costs for consumers and purchasers, creating a state strategy for controlling the cost of health care and ensuring affordability for consumers and purchasers, and enforcing cost targets.” These are grand and important goals, implemented in a painstaking public process through thousands of pages of analysis and spreadsheets, and through hundreds of hours of deliberation. Staff writer Pam Marino, who covers health care, has attended many dozens of those hours of deliberation virtually or in person. As Marino has reported, that led OHCA to implement a 3-percent cap on annual spending increases at hospitals across the state. Even before that cap phases in—and as hospitals face a barrage of challenges, including the looming prospect of $880 billion in Medicaid cuts from the feds—OHCA has moved on to evaluate an even more stringent cap on what it has defined as high-cost hospitals. Two local hospitals, Salinas Valley Health and Community Hospital of the Monterey Peninsula, made OHCA’s list of 11. (For more about the board’s vote on April 22, see story, p. 12.) Officials at SVH and Montage, the parent company of CHOMP, are on the defense. OHCA has played a much-needed public forum for people to vent about high hospital bills, and the hospitals have been cast as villains; correspondence to OHCA weighing in for and against the cap came in at 528 pages long. While hospital leaders acknowledge there are opportunities to find more efficiencies, they are deeply frustrated by what seems like a misunderstanding of their accounting. A big part of SVH and Montage officials’ frustration comes from OHCA’s classification of these institutions as “hospitals” rather than as “systems.” Both hospitals make money, but other operations— like clinics and outpatient care—are money losers, and they are subsidized by the hospitals’ positive balance sheets. Just this month, Montage announced it was absorbing Monterey Spine and Joint; it will reopen on April 28 as Montage Orthopedics and Sports Medicine. “Sustainability of private practice has really become a thing of the past,” Dr. Samera Kasim, an orthopedic physician at MSJ, told Marino. And in Salinas, SVH is taking over Pacific Coast Pediatrics on May 1 as part of PrimeCare. That two giants continue to consolidate medical practices presents obvious problems, but it also illuminates the even bigger problem: That it’s too expensive to run an independent medical office in Monterey County. What’s even more frustrating is that even if hospitals can and do shrink their margins, there is a link missing: the behemoth in-between entities in this equation, insurance companies, are under no obligation to pass along those savings to patients. As OHCA was taking shape, state lawmakers were considering whether to implement single-payer health care in California. The concept known as CalCare, introduced by Assemblymember Ash Kalra, D-San Jose, would have saved an estimated $42 billion annually in administrative costs alone. In 2024, the Assembly Appropriations Committee pulled CalCare off the table. “We must remain committed to advocating for a more inclusive and equitable health care system for all,” Kalra said in a statement. That is part of OHCA’s mission, but even cost caps won’t get us there—and they might backfire. “We rely heavily on SVH for the specialty services we cannot offer,” Clínica de Salud del Valle de Salinas CEO Dr. Max Cuevas wrote, listing cardiology, wound care and oncology. “Penalizing SVH would undermine the health and well-being of our most underserved patients.” Sara Rubin is the Weekly’s editor. Reach her at sara@montereycountynow.com. Bleeding Out The health care system is broken. Efforts to fix it are missing the mark. By Sara Rubin TRACK SUIT…Squid oozes around the courthouse regularly, but not being a trained lawyer and all, Squid’s never had a good sense for which side holds a stronger hand. It probably doesn’t help that when Squid reads the word tort, Squid initially thinks of cake. So Squid kept an open mind last year when Todd Clark, co-owner and founder of Museum of Handcar Technology, the Marina-based business that offers handcar tours on the rails of the Monterey Branch Line, sued the Transportation Agency for Monterey County and the City of Marina in federal court for violating the company’s First Amendment rights, arguing the agencies didn’t renew Clark’s lease on the tracks— which TAMC owns—because of retaliation against his vocal opposition to Monterey-Salinas Transit’s SURF! busway. But April 14, Squid got some clarity when a federal judge granted the museum a partial, preliminary injunction against TAMC that will allow the company to remain operating on the tracks until TAMC can show evidence that the SURF! project is fully funded, has all the necessary permits and that construction cannot begin until the museum is evicted. The judge cited statements posted on Nextdoor by Marina Mayor Bruce Delgado, a TAMC board member, in validating Clark’s claim: “TAMC hasn’t handled handcar lease termination well but from my inside view I’m not surprised. You poke the bear and bear is not always kind.” That may be true, but a bear—unlike TAMC—doesn’t have to abide by the U.S. Constitution. BIG AND BIGGER…Squid’s lair is a simple place. That was especially evident to Squid upon attending a Monterey County Board of Supervisors meeting, where Squid quickly realized that lair means different things to different people, most notably Amy McDougall and Rene Peinado, who want approval to build a six-story, single-family dwelling on Oakwood Circle in Carmel Valley. There were conflicting claims about the size of the lair, hovering around 15,000 square feet, as well as differing interpretations of builder’s remedy, a state policy intended to spur low-income housing projects forward. Laura Strazzo, the attorney representing McDougall and Peinado, threatened litigation, but the supervisors were unimpressed. “I always think it’s a weak argument when you’re trying to make the threat of litigation override all the many concerns we have about the substance of the application itself,” Luis Alejo said. Maybe McDougall and Peinado thought Chris Lopez would be a sure yes vote, but they would have thought wrong. “I was recently accused of never seeing a housing project I didn’t like,” Lopez said. “Well, here we are today. That day has arrived.” The board voted unanimously to send the project back to the Planning Commission, where there’s a second chance at a smaller lair. THE LOCAL SPIN SQUID FRY THE MISSION OF MONTEREY COUNTY WEEKLY IS TO INSPIRE INDEPENDENT THINKING AND CONSCIOUS ACTION, ETC. “Private practice has become a thing of the past.” SEND SQUID A TIP: squid@montereycountynow.com
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