Healthy Attitude

Budget conferees in Sacramento, despite the extraordinary limitations placed on them, have provided additional funding for two critical health-care priorities. For that they must be congratulated. And with that action they have provided another opportunity for Gov. George Deukmejian to respond to these growing problems.

The additional funding is for the Medi-Cal program, and would enhance compensation for pre-natal care and for hospitals handling a disproportionate number of Medi-Cal cases and other cases for which there is inadequate funding--sometimes no funding. About $15 million would be used to increase the fees paid to obstetricians for the care of low-income mothers, and $20.5 million would be used to enhance Medi-Cal payments to the hospitals, many of them county hospitals, affected by high levels of undercompensated care. Furthermore, the legislators have included a 3% increase across the board in Medi-Cal cost-of-living adjustments and a 1% increase in state payments for medically indigent adults.

This response is welcome, and consistent with the efforts of the Legislature and the governor in the last two years to begin facing up to the growing crisis in health-care finance. To do less would be to invite far greater costs in the future. The prenatal program, for example, is one of the most cost-effective in all of medicine, with research indicating that for every $1 spent on pre-natal care there is a saving of $1.70 in the costs of intensive care for the prematurely born and for birth complications that could have been prevented with an effective pre-natal program. Under the state program, the present $518 fee paid to obstetricians will be raised to $900, with additional fees up to a total of $1,100 in special cases. This is still below the normal rates for obstetrical care, but may help bring back to the Medi-Cal program some of the obstetricians driven away by fees made all the more inadequate by rising costs of malpractice insurance.

At a time of extreme budget cutting in both Washington and the states, the proposed increases are particularly welcome. Nevertheless, they are only palliatives. The consequences of Gramm-Rudman in Congress, Proposition 4 in Sacramento and Proposition 13 at the local level in California have encouraged the folly of underfunding in health care. The world’s richest nation still has 35 million citizens without any health-care protection, either governmental or through private insurance.

California, with its resources and imaginative governmental leadership, has an opportunity to construct a health-care model for the nation. The state’s sense of responsibility is evident in these modest but important budget commitments.