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COMMENTARY ON THE BUDGET : Who Says Supervisors' Spending Priorities Are the Public's? : Yes, law enforcement is crucial, but that doesn't mean scarce funds can be wasted while equally crucial health services are slashed. It's not too late to make changes for the better.

August 01, 1993|HOWARD WAITZKIN and JEAN FORBATH | Dr. Howard Waitzkin is a professor of internal medicine and social sciences at UC Irvine. Jean Forbath is past chairwoman of the Orange County Human Relations Commission and past director of Share Our Selves. and

It's almost a truism to state that a society's priorities and values are clearly reflected in the budgets they adopt. The Orange County Board of Supervisors believes that the budget it passes each year does just that. We think many residents would disagree and declare that spending over 50% of county dollars on public protection and only 8% on health care, and closing public libraries while leaving vast flood control district dollar reserves untouched, do not reflect our values.

Although public safety obviously is a high priority to Orange County voters, this prioritizing does not mean that waste should be permitted in the public protection budget.

Relatively minor cuts and shifts on a percentage basis from public protection would make an enormous difference to urgently needed health and mental health services.

These shifts also are quite appropriate, in view of the fact that Orange County spends less on health and mental health--both on a per capita basis and as a percentage of the total budget--than other comparable Southern California counties. The main reason that Orange County spends less on health and mental health is that we spend much more, on a relative basis, than other counties to support the sheriff's and district attorney's operations.

During the county's budget hearings, several supervisors asked good questions about specific budgetary components that could be cut or streamlined under public protection. These potential savings include greater reimbursement for shared helicopter use, hazardous materials responses and several other services currently provided by the county.

Our own budget study has found many (public protection) budget lines with millions of dollars of unexplained spending that we can't figure out. The Sheriff's Department has not explained these mysteries. For example, in the line item budget for the Sheriff's Narcotics Program, there is $3.9 million in "special departmental expense" and for the Regional Narcotics Suppression Program, $3.8 million for "special departmental expense." Such "big ticket" items deserve specification and evaluation to be taken seriously as priority items.

Further, in the Regional Narcotics Suppression Program, there is a very substantial amount of interest accrued each year--$518,000 in 1991, $570,000 in '92, $300,000 in '93. That implies a very large principal not being spent down. We think Orange County's values would be reflected if even just the interest were used for such programs as drug prevention and drug treatment.

Another overall problem is that negotiations about possible cuts in the public protection budget generally accept the previous year's overall allocation. And relatively small percentage reductions are requested, rather than reviewing critically all the line items in the budget, or the relative proportion of county general funds to be spent on public protection versus other important areas. This practice, acknowledged by county staff, encourages the approval of millions of dollars without detailed critical appraisal. Because the public protection budget is so huge, the lack of critical appraisal has devastating financial implications for other programs.

The current budget-balancing measures call for cutbacks in mental health, indigent medical care, AIDS education and other essential services. We recently completed a study of the county's Medical Services for Indigents Program (MSI), which is intended to serve medically indigent adults, and found major problems of access.

First, few doctors participate in the program, mainly because the reimbursement rate is so low; less than 10 cents on the dollar of usual charges. In some specialties, like neurology and orthopedics, we were unable to find a single private practitioner who will accept MSI. Other problems of the program include: cumbersome eligibility processing; excessive waiting times for needed services; burdensome patient co-payment and deposit policies; and a narrow range of services provided.

We know that patients suffer because of inadequate county funding of the indigent care program. To cut back even further, while we see questionable spending in the public protection budget, is unreasonable.

The OPTIMA program, which is several years off, will not address the critical problems of health and mental health that exist now and that will become worse if further cuts are made in those areas.

The final budget will not be adopted until later this month, so there is still time to encourage a more disciplined, critical evaluation of Orange County's extensive expenditure on public protection and a more thoughtful approach to improving county support for health and mental health services.

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