Health Care Commitment

Nowhere is it more true than in ballot initiatives that the large print giveth and the small print taketh away.

The resounding defeat of Measure O, which would have transferred control of $260 million in tobacco settlement funds from county supervisors to a few private hospitals, can be credited to the vigorous campaign that helped voters see that the large print--”spend these funds entirely on health care”--brought with it pages of small print that essentially added “in ways that mainly benefit our own hospitals and doctors.”

Voters chose by a 2-to-1 margin to keep that $260 million in the public domain and to trust the Board of Supervisors to spend it wisely. The board indeed pledged to do so, giving final approval just a week before election day to an ordinance that commits it to use the tobacco settlement money solely to provide and expand health care in our community.

Now it is the Board of Supervisors’ turn to make sure that its own small print--and its actions--remain true to the intention so clearly stated in its large print.

The ordinance commits the board to spend $10 million of the tobacco funds every year for the next five years on a range of health care programs, from anti-smoking campaigns to mental health services. A portion of the money will also be allocated to private hospitals to offset their cost of providing health care services to the poor and uninsured. Nonprofit community groups will get some of the money, and some will be used to secure state and federal matching grants.

Two oversight committees, appointed by the supervisors, will recommend how the money should be divided. Final say on expenditures, however, will come from the supervisors. Although the ordinance dictates a spending plan for the first five years, that plan can be changed every year, and the tobacco settlement money is expected to keep coming for 25 years.

It is true, as Measure O supporters often argued, that if the board had committed the money to health care programs sooner, there would have been no need for the initiative. The challenge now is for the board to prove itself worthy of the trust voters have given.

The challenge is to adjust spending priorities to keep pace with the county’s changing needs without going outside the broad category of health care. We believe that the board can do this in a manner that remains true to both the letter and spirit of its pledge.

And as it does so, we believe that it can demonstrate ways to improve on its controversial public safety ordinance, which directs more than $40 million per year in tax revenue to four county public safety agencies. That ordinance was approved by supervisors in 1995, two years after voters approved statewide Proposition 172, a public safety tax initiative.

In that case, the large print was “spend these funds entirely on public safety”--a mandate with which we heartily concur. But in that case, as in the case of Measure O, the potential benefit to the public of this annual windfall is severely restricted by small print that essentially says “in ways that mainly benefit the sheriff’s department, district attorney’s office, public defender’s office and probation department.”

The Board of Supervisors needs to ensure that the tobacco settlement money is spent on the full range of health care needs and the Proposition 172 money is spent on the full range of public safety needs.

Voters chose by a 2-to-1 margin to keep that $260 million in the public domain and to trust the Board of Supervisors to spend it wisely.