COMMENTARY ON HEALTH CARE : The County Can’t Afford Not to Provide Preventive Services : With budgets shrinking, police, health and social workers and others must work together to save lives, time and money.

Tuesday is D-Day for Orange County. It’s Decision Day on the 1993-94 county budget, when the Board of Supervisors will listen to the public on what they think the community needs.

But it won’t make a significant difference because the board is locked into state laws and mandates, its own historical pattern of budget policies and the tyranny of current economic problems.

Not that the supervisors haven’t tried. Utilizing the creative information and initiative of County Administrative Officer Ernie Schneider and his staff, the board took a giant step to encourage citizen participation in the budget process this year. Meetings with state legislators, information sessions and advance hearings gave concerned voters a new chance to learn the process and air their views.

However, preliminary actions of the county supervisors demonstrate the boundaries on their decision-making ability as well as their inclinations. For example, despite the strong presentation of the Health Care Council and many of its 62 organizations represented in its large coalition, the county Health Care Agency again will be short-ended from the general funds available at the discretion of the board members.

The proposed budget imposes an 11.5% reduction of general fund allocation to the Health Care Agency, twice the cut in the criminal justice budget. The Health Care Agency will receive only 9% of general funds contrasted with 50% to public protection and 17% to general government and services. What does that say about Orange County public policies?

Add to that the fact that the health care allocations in the last 14 years have dropped from 38% to 16% of the total budget; that Orange County has the second lowest per capita allocations of all counties in the state; and that it is near the bottom of all California counties in allocations to medical services for the indigent.

Almost everyone recognizes that the lot of the supervisors is not a happy one. The federal and state governments have been shifting costs to counties for a decade, and Orange County has shifted in turn to the providers and consumers via reduced public and city support and increased service fees. The “realignment” shift of Gov. Pete Wilson gave the county virtually complete responsibility for health, mental health and social services with a limited tax support, the real impact of which the board has not yet realized.

Underneath it all is the devastating effect of Proposition 13, the unjust tax measure designed to cripple sound government, which now faces the citizens of California with its prophesied effect.

These strictures do not allow the Board of Supervisors much room for decisions, particularly when they are bound by their own dead-end policies, those that leave problems unsolved. But, with a view of “what can we do locally?”, the Health Care Council recommended a realistic start: Look at all county programs with an eye to preventive services, designed to impact the limitless demand for emergency or dead-end services.

For example, half the prisoners in jails are there for victimless crimes, crimes against themselves, not against others or property. A small allocation of county general funds reassigned to community clinics for mental health, drug and alcohol services would cut into the jail’s revolving-door pattern for the mentally ill and alcoholics.

The national scandal of determinate sentencing for drug use, which puts away young people for major sections of their life and hardens them into trained criminals, is being recognized as futile. Money for additional jails has reached its limit. Those persons with demonstrated antisocial actions should receive, as U.S. Atty. Gen. Janet Reno advocates, rapid and appropriate punishment, but the punishment no longer fits the crime.

A prevention approach has many creative and financially economical potentials. For example, nearly half the calls for police intervention involve correctable family disputes, despite the impression given by TV nightly news spectaculars.

Eastern cities have developed programs that have social workers on call or riding with squad cars. They intervene with a professional, prevention approach rather than the legal or adversarial one that crowds the courts. After early reactions to this seeming assault on their macho image, police officers see and welcome an intervention for which they are not usually trained.

Just as the Health Care Council’s support for prenatal service for all pregnant women saved thousands of dollars by preventing traumatic births, creative prevention techniques can help thousands and save thousands.

Only when Orange County residents demand a change from dead-end punitive policies to the rehabilitation and re-education policies of a civilized society will we break the cycle of throwing money at social problems created by economic forces beyond a person’s control.