For years, California's hospitals and government-run health programs have been forced to offer translation to patients who don't speak English. Now, private health plans are next. SB-853, passed in the twilight of former Gov. Gray Davis' reign, is finally sinking its teeth into California's health plans. By July 1, each plan must submit its "quality assurance plan" for translation services to the state, and by January 1, 2009,each plan must have a translation program up and running.

One plan has reported an estimated cost of $20 million to comply with the regs. Others have declined to state their estimates. (What's the point? There's no way to ignore it.)

Get it? An immigrant is not supposed to learn English. Rather, the English-speaker is expected to have his already high health premiums subsidise the non-English speaker's inability to understand a health insurance contract into which he has voluntarily entered.

Even worse, the mandate will likely harm health care for non-English speakers because health plans will be tempted to underwrite for English fluency!

Even advocates of English as an official language are wobbly on this one. Rob Toonkel, a spokesman for D.C.-based U.S. English, said basic healthcare services generally do not draw much ire: "I don't think anyone in their right mind would tell someone in a health emergency, 'Sorry, you didn't learn English, so too bad,' " he said. "If we English-speakers were in another country, you bet we'd hope there would be translators on hand to help us understand."

Well, as an immigrant, albeit a native English speaker, I disagree. When I lived in Germany, it never entered my kopf that I had a "right" to communicate with my health insurer in English (nor the police nor city hall, either). I learned German - and it only took me a few months.

Now, if I was an American travelling in Germany and had to go to the hospital, I'd expect a translator, and (perhaps) expect my U.S. health plan to pay for the service - but that is so obviously different than expecting a U.S health plan operating within the U.S to do so that I shouldn't even have to bring up the distinction.

What about the old stand-by for an elderly immigrant who has not picked up English - a close friend or relative coming along to the doctor's office to help out? Nope, not good enough: we're talking about a full-blown government-dictated translation bureaucracy here, folks.

It gets even worse, state senator Leland Yee wants to amend the code to outlaw people using family members to translate - especially if they are children. Can't trust them kids, don't you see?

$20 million here, $20 million there for translation services - maybe not much in $2 trillion of health spending. But this is how expensive benefit mandates add up - one at a time.