AIDS: Facing Reality
The California Senate has an opportunity this week to address a crucial need in the state’s response to the AIDS pandemic by providing additional resources for mental-health programs.
The bill, SB 2856, is by any measure a modest step, already trimmed in committee from $8 million to $4 million. But it would at least recognize the great need for expanded facilities and services as the incidence of dementia among victims of the disease increases daily. And it would signal a commitment to action.
The AIDS legislative agenda includes other critically important bills that will be making their way to the floor of the Assembly and Senate in the days ahead. The pressure in an election year for at least the appearance of action on this problem raises the risk of irresponsible action. But there appears to be growing recognition of the need for bipartisan efforts directed at reinforcing the effort already being made by public-health experts.
Of equal importance with the mental-health legislation are bills to establish state licensing for residential and hospice-care facilities for victims of AIDS. Increased funding through Medi-Cal and from the Los Angeles County Board of Supervisors will be available in the months ahead for these alternatives to hospitalization. They are important both because they offer more humane and appropriate treatment settings and because the cost is substantially less than in acute-care facilities. But there already is evidence of the risks of doing more harm than good when these facilities are not controlled under state standards.
The critical need for public funding for the services associated with AIDS is only a portion of the broader needs that could easily be neglected in the crisis climate that is now apparent in Sacramento. The unexpected shortfall in state income has unbalanced Gov. George Deukmejian’s original budget. The resistance that the governor encountered from leaders of his own party in the Legislature to any increase in revenue to meet the shortfall is more than an embarrassment to the governor. It suggests an irresponsible refusal to face needs in the whole span of major services including health care and education--needs that will not go away, needs that if neglected will only create higher costs in the future, needs that touch in vital ways the life of every Californian. The economic foolishness of inadequate funding is nowhere more evident that in prenatal care for poor families.
The Los Angeles County budget for health services is a case in point. It foresees a major effort to rebuild the crumbling trauma and emergency-room networks while enlarging AIDS services and facing up to an outbreak of venereal disease. But the Department of Health Services budget includes $87 million of income that is problematic--that is, about which there is real doubt that it will materialize. The success of the county’s programs will depend in major measure on the willingness of the state and federal governments to provide more adequate funding, including the state’s obligations to help with the cost of uncompensated care in hospitals, the heart of the emergency-room crisis.
These needs are real. The approval of SB 2856 would be an indication of the state senators’ willingness to face that reality.