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The State of Health Care in America

July 02, 1989

There are certain societal problems for which we all recognize the government has a leadership responsibility. No one disagrees that only our government can provide for the defense of our republic. No one denies the government has a responsibility for enforcing our laws, protecting our environment and providing highways for our use.

The recent events (in which UCI Medical Center) no longer can provide obstetric care to half the women seeking it is an example of government avoiding its responsibility.

Up until six years ago, there was a well-balanced medical care system in California where the "haves" paid for the "have nots" through "cost shifting." With the advent of federal hospital cost controls and the Medicare fixing of physician fees, the funds to care for the disadvantaged members of our society disappeared. Compounding the problem, the state of California began cutting back on Medi-Cal funding in 1982. Just to restore funding to Medi-Cal to the pre-1982 level would take $1 billion. On top of this we have had a growing percentage of Californians (now 22%) that don't qualify for Medi-Cal and don't have insurance; 70% of these people are employed or are the dependents of the employed. These people also require care that goes uncompensated and for which there are no longer "cost shifting" funds available.

The sad tale in Orange County is just the tip of the iceberg. It is not just pregnant Medi-Cal patients but a significant portion of middle-class America that has a problem with access to medical care. If solutions are not found soon, it will cost everyone more dearly than they would wish. The time has come in both Sacramento and our counties for political leaders to step forward and accept responsibilities that are duly theirs.

RUSSELL C. EWING II, MD

President, Orange County Medical Assn.

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