It’s Just My Opinion
By Harris R. Sherline
“Trust Me” (or Us)
Another
health care proposal is now working its way through government, local
government, that is.
In a
recent debate hosted by the Santa Barbara County Taxpayers Association, two
County Supervisors, Salud Carbajal and Brooks Firestone, made the case for and
against a proposal that would have our County government fund a health care
plan for some 16,000 uninsured children.
The discussion was a graphic example of the differences between the Left
and Right in the American political thought process of today.
The two
Supervisors set the background for their discussion by pointing out that only
$189 million of the County’s current $750 million budget is available for discretionary
spending. The balance is
pass-through funding from various federal and state programs, such as welfare.
On the
Left, Supervisor Carbajal offered the following rationale for having the County
assume responsibility for providing health care for uninsured children:
·
There
are approximately 16,000 children in Santa Barbara County who do not have
health insurance and it is, or should be, County government’s responsibility to
cover them. The proposal initially
targets only 500 children, with the expectation that it will expand to 5,000 or
6,000 over five years. Since these
children are not currently enrolled in any Federal or state plans, such as the Medi-Cal
or the Healthy Kids programs, the County must do it.
·
The new
plan will start in the next budget cycle by allocating $1 million to provide
for the medical, dental and mental health care of 500 children (through age
18). It would be modeled after the
state’s Medi-Cal program for low-income patients, which has an approved list of
health care providers who bill the state for their services.
·
The
money to pay for children’s health care can be found by rethinking the County’s
budget priorities and reallocating savings (cuts) from various departmental
budgets.
·
The
initial $1 million funding would be expanded over time, as more savings are
identified by continuing to reassess the County’s budget priorities.
·
The
County’s commitment would eventually be phased out, when the children are
insured by state or Federal programs.
Salud
Carbajal’s bottom line is that everyone in America should have guaranteed
health care that is or should be the responsibility of County government, and that
we must do this “for the children.”
We can’t afford to wait, he argued, citing the high cost of caring for
them in hospital emergency rooms.
On the Right, Supervisor Firestone offered the following
reasons why the County should not undertake this program:
·
Santa
Barbara County does not have the money to assume any additional financial responsibilities. Although the current year’s budget is
balanced, the trend clearly shows a growing gap between expenditures and
revenues, with outgo exceeding income by about $15 million in five years (fiscal
year 2011-12). The shortfall will begin in the next fiscal year.
·
Eighty-seven
percent of the County’s discretionary budget (General Fund) is provided by
property taxes, and County records show that the revenue from this source is
growing at a slower rate than previously, which means that over the next five
years the budget shortfall will actually be greater than projected.
·
The
idea of finding savings in various parts of the budget to pay for the program
is unrealistic. Not only is there no
money available for the initial $1 million startup cost, but any savings that
can be found in future years will be needed just to keep up with the growing
gap between expenditures and revenues.
Furthermore, the proposal assumes that the initial $1 million cost of
this program will increase to between $7 million and $9 million within five
years. So, if we are already
anticipating a budget shortfall of some $15 million in that time frame, where
is another $7 million a year for a health care program going to come from?
·
Projected
costs in the County’s staff report for the children’s health care proposal have
been significantly understated.
For example, no Cost of Living (COL) increases were included in the
estimate.
·
The
program will become a magnet that will attract people from other areas, who are
likely to move to Santa Barbara County to take advantage of it. This would add to the projected number
of children who need coverage, thereby increasing the cost even more.
·
Both
the federal and state (CA) governments are currently moving in the direction of
providing universal health care coverage, so the County should not get involved
only to discontinue its own plan when that happens.
Brooks
Firestone’s bottom line is that the County simply cannot afford to take on
another expense for which it does not have the money and that relying on
savings by reordering budget priorities is unrealistic. It won’t happen, he argues, because the
County will be looking for every possible source of revenue and savings it can
find just to keep up with the growth in expenditures that is already expected.
There is
another issue involved in the County’s health care proposal that was not
discussed at the meeting, which buttresses the case against it.
Modeled
after California’s Medi-Cal program, the proposal conveniently ignores the fact
that Medi-Cal is notorious for underpaying its health care providers, so much
so that a great many doctors and other health care professionals do not accept
these patients. Supervisor
Carbajal stated, for example, that the fee for a doctor’s office visit is about
$30.00, a number that is probably less than a third of what is currently
considered standard.
During
the years I was involved with Santa Ynez Valley Hospital, there was only one
local doctor who would accept any Medi-Cal patients at all (because of
excessively low fees), other than the Chumash Indian Clinic, which was just getting
started at the time.
Even specialists
who were called in to treat Medi-Cal patients in the Hospital’s ER often didn’t
even bother to bill the state because they felt it wasn’t worth the hassle of
trying to get paid, and inadequately at that.
The only
way to fix this would be to increase the County’s fee schedule, which would
just add to the need for additional funding. And, more funding for the program would necessarily require
more cuts elsewhere in the County’s budget.
By any
measure, the idea is a loser. For
one thing, it relies on the “trust me” factor, which is invariably the fallback
position of politicians and bureaucrats when they are trying to sell something
to the public.
Well, I
don’t trust them! And, apparently
Brooks Firestone doesn’t either, which puts me in good company. I don’t trust them to find appropriate
cuts in the existing budget to fund this new program and, if they could, I
don’t trust them to prevent those same cuts from creeping back into the
budget. I don’t trust them to
control the costs of this new program, and I don’t trust them to phase it out
when the federal and or state governments finally set up their own programs to
fill the same need.
Contrary
to what seems to be the prevailing thinking in government these days, we can’t
have everything we want in life.
Like it or not, there are limits, and they are often set by what we can
afford.
Here’s a
novel thought: If the Board of Supervisors can find places to cut the County’s
budget by reassessing their priorities, how about just returning the savings to
the taxpayers who are providing the money in the first place?
It’s silly, I know, but, that’s just my opinion.
© 2007
Harris R. Sherline, All Rights Reserved