The New Health Dialogue

Though more people must rely on it in this time of economic hardship, the safety net in California is about to get a whole lot more holes. 

To deal with a $19.9 billion budget deficit, Gov. Schwarzenegger proposes to slash $2.4 billion from health and human services. This is on top of the roughly $2 billion in cuts to health care that were part of last year’s budget deal.  Attempting to explain the austerity of his budget proposals,  the governor declared, “In this budget I refuse to raise taxes, because there are so many other areas where Sacramento can be smarter, more efficient, and save precious taxpayer dollars.” On one level, the governor is absolutely right  that both public and private payers need to work together to transform how medical care is delivered to get dramatically better value for medical spending. This year, for example, a broad group of California-stakeholders has convened in order to develop proposals to do just that. However, this is a project that will yield results gradually. And, it is worth noting that private industry has been, if anything, less successful in controlling cost growth than have public programs.

So, in the short run, these cuts are not about improving government or making it more efficient.  They simply eliminate real services for real people who really depend on them.  The Damage Already Done, a report issued by Health Access California, showcased the impact of last year’s budget cuts including the fact that, “Almost three million low-income adults have lost ten important benefits, such as dental care, vision care, speech therapy, and psychological services.”

The governor may believe that the wealthy taxpayers on which the state largely depends should not subsidize these services. This is a valid political argument, but it needs to be made explicitly and not dressed up as “efficiency.” Low-income Californians haven’t had dental services provided to them more efficiently over the course of the past year. They simply haven’t had assistance in paying for dental health.

But Schwarzenegger is in an extremely difficult position because of the state’s requirement that two-thirds of the legislature vote for the passage of the state budget. This Republican Governor has no ability to deliver the Republican votes necessary to pass the budget. 

In California this year, we will be witnessing a classic case of the irresistible force (the moral and economic case for preserving public goods such as the safety net and the University of California), versus the immovable object (Republican opposition to raising taxes). The wild card is that as many as a dozen initiatives may appear on the ballot this year proposing everything from new voter-approved funding for social programs, to changes to the budget process, to a convention to rewrite the state’s Constitution. And no one can honestly tell you that they know what is going to happen.