It's important to realize that foundations can do a lot more than provide direct service. If all they do is provide direct service, they are not going to have the resources to provide the services at the level required. A foundation like this, that makes $40 million a year in grants--even if it was all direct service--doesn't come close to providing the services needed. We're focused on prevention so, hopefully, the type of services that we're paying for--for example, prenatal care, family planning, immunization--are actually going to help decrease the cost.
Q: Two of the largest conversions--yours and the one from Blue Cross of California--occurred in this state. That means you and those two foundations help set the agenda for health-care philanthropy here. If projects don't fall within your target areas, isn't there a grave risk that some innovative programs fall through the cracks?
A: Oh, absolutely, which is one of the reasons that we have five priority areas. But we also have what we call a special projects fund. That allows us to deal with what you're talking about--a creative, important, needed program, that would come to our attention, we still have the ability to fund even though it's not within one of those five priority areas.
This is where most of the work we've done around federal devolution has been done--out of the special projects fund. We've made millions of dollars in grants over the last two years to shore up community clinics, to provide funds for community advocates around access to health care, to provide some monitoring and evaluation of MediCal managed care as it's being implemented in the different counties--none of which fit under our priority areas, but all of which fit under the rubric of improving the health of the people of California.
Q: Do you feel it's a fair description that you have a lot of influence on the money that gets spent on health care and perhaps on what the state will ultimately do?
A: I'm not sure about a lot of influence. There is a potential to be helpful. Foundations which care about the health of the people of the state can certainly put some of their grant-making money into programs and institutions that help educate policy-makers and opinion leaders in some of the thinking about how best to write policies and programs that will help enhance the health of the people of the state.
The ship of state is tough to influence, and to think that just because a foundation makes $40 million in grants a year, it's going to be able to influence state policy--that, in and of itself, will not do that. We give funds to the Health Policy Institute at UCLA. They provide good information to policy-makers on a lot of the issues. We have funded the California Center for Health Improvement in Sacramento. It has conducted regular surveys of the state population and their opinions about health issues and provided that in informational packets to the Legislature. Last year, they did one on welfare reform. Welfare reform has a clear potential to impact health of those affected by it.
Those are the ways you can have some influence, but we are not--these two foundations--going to be able to set the agenda for health care in California.
Q: The health-care industry has so much more money--
A: Oh, absolutely. And not only that, but the health-care industry can directly lobby the state for changes. Private foundations are prohibited from lobbying. Again, we can provide information and education, but this foundation's mission is to improve the health of the people of California. Our way of doing it is by making grants.
Q: Four years ago, the foundation spent about $4 million on TV commercials on Proposition 188 that the tobacco industry was sponsoring. It was defeated. Now, isn't that lobbying?
A: It certainly would have been lobbying if we had taken a stance on it one way or the other. If we'd have said, "Vote Yes for 188," or "Vote No on 188," that would have crossed the line. We gave a grant to another organization to do a public education campaign that was neutral on 188. It basically said the citizens of this state should get the facts about that ballot initiative. It was an important health initiative. People who saw those ads were shown what one side said about it and what another side said about it--straight out of the voter guide.
I personally believe that in a democracy, around any issue, whether it's health or something else, an informed public is best. This is another role that foundations have an opportunity to play--providing grants to entities that can help inform the public.
Q: Some people applaud the foundation's advocacy stance and the attempts to make systemic change; other people say it's out of line. How far do you think you can go with advocacy?