Bad to Worse

The Administration of Gov. George Deukmejian, faced with a new financial crisis in the Medi-Cal health-services program for low-income families, is expected to order a further squeeze today on the doctors and hospitals that provide the care. That would only make a bad situation worse.

Sacramento has for too long been forcing the providers of health-care services to bear a disproportionate share of the cost for these services that should be covered, and covered amply, by government funding. As a result, services are diminishing. San Bernardino County Medical Center is the latest to drop out of the Medi-Cal program; it left because costs were $4 million a year above state payments. Pre-natal care, perhaps the most cost-effective of all health services, is weakened by the understandable refusal of many obstetricians to participate because of ridiculously low fees. In Medi-Cal dental services, unlike regular dental practices, the extraction of teeth is the rule rather than the exception because, for most patients, Medi-Cal does not cover root-canal work. Furthermore, many dentists, like many medical doctors, refuse or severely limit the numbers of Medi-Cal patients because of the inadequate compensation.

The facts are clear. Medi-Cal is underfunded,the providers of Medi-Cal services are undercompensated, and cutting costs will only worsen a grave situation for low-income people.

The budget “crisis” is hardly a surprise. Deukmejian chose, in drafting this year’s budget, the lowest estimate of Medi-Cal costs and so invited a shortfall, now set at mid-point in the fiscal year. The money budgeted was not realistic. That bit of fiscal acrobatics, however, diverted voters until the November elections were past.

This is not a time for a meat ax. It is time for a supplemental appropriation to assure full service with undiminished fees for the balance of this year. The state’s reserve can be drawn on if necessary. That can be done without fracturing the limits of the Gann initiative that is now coming into effect.

But the governor has hinted only that he will address the shortfall by trimming fees rather than by increasing revenue. And he has further hinted that the cuts will be even more severe for next year, when the Gann limits are in full force. His staff has spoken of “restructuring” Medi-Cal, suggesting new restraints on what already is a woefully underfunded program. This has raised further doubts about state funding for medically indigent adults, whose health care was dumped onto the counties in an earlier state fiscal crisis under Gov. Edmund G. Brown Jr.

Two meetings will be held in Sacramento today. The first will be between the governor’s principal assistants, including his chief of staff and health and finance chiefs, and representatives of the health-care providers’ organizations. The second will be open to the public. Both conform to legal requirements for notice before implementing the authority that he has to cut fees up to 10%.

There is concern among health-care professionals that the governor has yet to assign a high priority to health. His commitment to the support of education has won him national recognition. But he has provided no significant leadership in the health sphere at a time when needs are soaring. The experts may have misread his intentions for today. He could surprise us by seizing the initiative to make the California health-care system a model for the nation.