Now, Spend It Well

On election day, Californians approved two initiatives that approached health issues from opposite ends of the spectrum: One deals with exotic research for futuristic cures and the other with getting the most basic care to society’s most vulnerable citizens. But the challenges of implementing them are similar.

The biggest challenge is to ensure that the money is well spent. Proposition 71 authorizes the state to invest up to $3 billion over a decade for embryonic stem cell research. Proposition 63 authorizes $750 million a year to help provide mental health services to those who can’t afford them. Both propositions exempt their pet spending from the usual democratic constraints and reviews. They then turn around and invest vast authority in appointed commissions.

With the reelection of President Bush, Proposition 71 is now the nation’s main hope of advancing stem cell research beyond the stifling restriction the president put on it in 2001, when he limited federally funded scientists to working with only a handful of mostly contaminated embryonic lines. That led many top U.S. researchers to emigrate to more scientifically permissive nations, like Britain. California now has the clout to lure them back. It should waste no time realizing the worst fears of the editors at London’s Financial Times, who last week flagged the measure as a “threat ... to Britain’s position as world leader in stem cell research.”

This page opposed Proposition 63 largely because its funding mechanism -- a 1% tax on personal income above $1 million -- commits vast state resources to a single purpose in perpetuity, no matter what. The good news is that the money could prove useful. Contrary to popular belief, mental health care is one of the easiest medical expenditures to assess. It may be hard to identify whether a cholesterol-lowering drug given to a patient in 1998 kept him from having a heart attack in 2002, but what Proposition 63 proposes to do is fairly straightforward: support counseling, job training, housing and other social service programs that can demonstrably help people avoid arrest, hold a job or at least stay off the streets.

Gov. Arnold Schwarzenegger and other state officials have just over a month to name the members of the citizen commissions that are supposed to supervise the implementation of both measures. The first thing the commissioners can do is forget the rhetoric used to sell the propositions. Embryonic stem cells will not “significantly reduce” the $110 billion spent on healthcare in California each year, as Silicon Valley developer Robert Klein, a leading proponent, claimed. Nor will Proposition 63 “help children avoid mental illness,” as its ballot argument contended. The commissioners’ job is to find more realistic goals and come up with a transparent way of measuring whether they’re being met.