To the hospitals and medical groups overwhelmed by a crush of uninsured patients, it seems like a sensible idea: ask voters to agree to a small charge on their phone bill to help keep emergency rooms open.
Their goal with Proposition 67 on the November ballot is to stabilize an emergency room and trauma center system in danger of collapse. Since the start of 2004, six facilities in Los Angeles County have shut down or announced they would close by the end of the year. Sixty-five have shut down statewide within the last decade.
"We have ambulances lined up with sick people," said Kacey Hansen, a trauma nurse at John Muir Medical Center in Walnut Creek. "There are enormous waits to get into the emergency room. Patients are in the hallways. We are there. This is the collapse we have been expecting.
"I don't think the public understands really how tentative the situation is," she said.
Yet voters thus far appear to be lukewarm to the idea of paying a few more quarters on their monthly phone bill to stop the hemorrhaging.
Analysts say the people behind Proposition 67 might have picked the wrong tax.
"The fundamental problem is they picked a tax that is coming out of a lot of pockets," Democratic political consultant Darry Sragow said. "Phone bills are already a source of great annoyance to customers. They have a laundry list of odd things on them."
It hasn't helped that both the Republican and Democratic parties, as well as a number of public safety organizations, have sided with the phone companies in a well-financed fight against the measure. Opponents question taxing a service with little connection to hospitals to pay for emergency care, and they are skeptical of how the state's hospitals would manage the $500 million the measure seeks to raise.
"This is as absurd as saying we should tax strawberries to pay for road construction," said Todd Harris, spokesman for the group Stop the Phone Tax.
The most recent Times Poll found that only 41% of likely voters support the measure, compared with 43% against. Though the rest remain undecided, pollsters say voters who still haven't made up their minds on an initiative this late in a campaign are likely to vote against it.
The state's major hospital advocacy group grew so frustrated by the inability to gain public support that it withdrew from the measure after spending $2.4 million to help get it on the ballot. Led by doctors organizations, the Coalition to Preserve Emergency Care continues to push forward with what is widely viewed in Sacramento as a longshot multimillion-dollar campaign.
"We are all groping for ways to pay for healthcare, given that the state is broke and the feds aren't coming to the rescue," said physician Jack Lewin, chief executive of the California Medical Assn. "Everyone wants healthcare, but they want someone else to pay for it. There was no place else to go."
Healthcare organizations decided to gamble on the phone tax idea after successfully raising taxes in Los Angeles and Alameda counties -- against long odds -- to bring relief to emergency rooms and trauma centers. Those measures were considered short-term fixes, and emergency room closures continued even after they were passed.
Proposition 67 would increase the surcharge on telephone bills that is used to pay for 911 services. The measure would raise taxes on in-state calls by as much as 3%.
Doctors say the money could keep emergency rooms afloat as the number of uninsured continues to rise.
"This is a Band-Aid," said Susan Fleischman, medical director at the nonprofit Venice Family Clinic. "It doesn't fix the healthcare system. But it pumps money into emergency rooms to keep them going."
Los Angeles County, she said, can't afford to lose any more emergency rooms. "You can be in a car accident around the corner from an emergency room, but it is so crowded they can't let paramedics bring you there," she said. "They are driving around, waiting for a place they can land."
More than 90% of the money raised through the increased phone tax would reimburse doctors and hospitals for treating patients in emergency rooms. Much of the rest would support health clinics for the uninsured, as well as training and equipment for firefighters and paramedics. Less than 1% would be used to improve the state's 911 system.
Opponents say hospitals should look elsewhere for money.
"There is just no connection," Harris said. "The idea that every time you pick up the phone you would be racking up new taxes is something I think most Californians find offensive."
Stop the Phone Tax campaign literature calls the idea "one more in a long history of outrageous taxes." It compares a phone tax increase to the poll taxes once used in the South to deter blacks from voting and the proposed tax on espresso drinkers that was ridiculed and rejected in Seattle.
The new tax would be limited to 50 cents a month for residential landlines, but that limit would not apply to cellphones or business lines.