Health Care Looking Better

The apportionment of new tobacco tax revenues approved in the waning hours of the last session of the Legislature has been largely, but not totally, respectful of the intentions of Proposition 99, the initiative overwhelmingly approved by the voters last year. Squabbling is inevitable when there is so little new revenue around to address a multitude of desperate problems. There are risks of abuse but they can be reduced by alert citizens.

Impoverished children will be the major beneficiaries of the money. Nothing is more important than that. Some of that benefit may be lost if counties are not careful about seeing that the tax money feeds expansion of services, as commanded by the initiative, and does not supplant existing funding, as forbidden by the initiative. There is at least the assurance of expanded screening for child disabilities, including funds to correct disabilities uncovered by the screening, and there is money for expanded primary-care clinics and perinatal care.

In the major appropriations for private hospitals and physicians, the priorities will be pediatrics and obstetrics along with emergency care. And in the major grants to the larger counties, the departments of health services are mandated to maintain existing financial efforts while assuring services to children to correct problems uncovered by the expanded health-screening program.

It will not be easy to monitor implementation, particularly in the largest counties. The discretion left to counties can work to encourage creativity and flexibility. One expert suggested that the only protections against abuse will be “community vigilance.” The California Department of Health Services will also review county plans.

The agreement was almost subverted by an aggressive tobacco industry campaign to dilute the anti-smoking educational program provided by the initiative. Cigarette makers sought to bar the use of the media, particularly television, to discourage young people from smoking. The vigor of the industry’s campaign lent credibility to the view of some public health officials that much of the cigarette advertising is designed to glamorize smoking in the eyes of the young. Now the state will have a virtually free hand to balance those advertisements.

Proposition 99 does not solve the basic funding crisis in health care in California. The $600 million a year generated by the tobacco tax will slightly help ease the problems in emergency rooms, hospitals and doctors’ offices where the poor and uninsured have increasing problems in gaining access to care. It will help reduce tobacco use, a major cause of critical health problems. The tobacco tax allocations approved last week will expire at the end of June in 1991. There will be an opportunity then for a fresh look at the best ways to use the funds.