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'Nerve Tonic' Might Embolden Our Duke on Health Care

October 01, 1987|GERALDINE DALLEK | Geraldine Dallek is a health-policy consultant based in Los Angeles. and

When it comes to helping the people of California obtain medical care, Gov. George Deukmejian gets a failing grade. It is well deserved. In the last legislative session the governor vetoed millions of dollars that would have provided health care for the working poor or uninsured, protected the state's troubled trauma system, boosted California's crumbling public hospitals, ensured that poor pregnant women get prenatal care, and funded AIDS health and education programs.

While Deukmejian denied health-care funds for the needy, he persuaded the state Legislature to refund more than $1 billion to California taxpayers. A small tax rebate may be good politics, but, given the pressing needs in our health-care system, it is poor social policy.

The governor's refusal to look at changing the state's spending cap or to consider any new financing scheme to address the health-care needs of the elderly, disabled and working poor is also unwise. Today many of California's elderly population are unable to pay the ever-increasing costs of medical goods and services, like prescription drugs and long-term care, for which they are not insured. Many of the chronically ill and disabled are also underinsured or, because of pre-existing conditions, denied health insurance altogether.

In addition to the underinsured, more than 5 million Californians--about 21% of the population under 65--have no health insurance. More than 75% of the uninsured are children and working poor; this population remains unprotected in case of illness.

Some would argue that the state cannot possibly find the money to deal with the present health-care crisis, or that we just don't know enough to fashion a program to provide additional protection for the underinsured and uninsured. Both arguments are specious. We may not be able to come up with an ideal state-funded health-care program for the poor, disabled and elderly, but we can make a beginning.

Franklin D. Roosevelt once said, "Better the occasional faults of a government that lives in a spirit of charity than the constant omission of a government frozen in the ice of its own indifference." Other governors around the country have taken this admonition to heart.

Innovative state health programs to help the elderly and working poor are not hard to find--at least outside California. This year Gov. Booth Gardner of Washington signed legislation establishing five state-subsidized pilot projects to insure the working poor. New York's Gov. Mario Cuomo approved legislation to help pay the costs of prescription drugs for the elderly poor and near-poor. Minnesota's Gov. Rudy Perpich approved the "Right Start" program that provides state-subsidized insurance to pregnant women and preschool children in working-poor families.

If these governors all get high marks, the A+ grade must go to the other "Duke"--Gov. Michael Dukakis of Massachusetts. He has proposed legislation that would insure all of that state's uninsured and assist the elderly poor with high health-care costs. If his legislation passes, as it is expected to do, it could revolutionize our health-care system.

To get his grade, Dukakis had to learn two lessons. First, the people of Massachusetts wanted change and were willing to pay for it. A state poll last April found that 89% of those surveyed believed that access to health care is a basic human right, and 79% were willing to pay higher state taxes to guarantee that right.

The second lesson, generally harder for politician to learn, is simply that rhetoric is not enough. What really counts is action. This lesson was brought home by a Boston Globe columnist, Bob Kuttner. Kuttner charged that Dukakis' attempt to please everyone, especially business, on the health-insurance issue resulted in "weak leadership and feeble policy." He challenged Dukakis to take a dose of "nerve tonic." The governor took his medicine and proposed his far-reaching health plan for the people of his state.

Gov. Deukmejian, how about a little "nerve tonic?"

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