A Blow to Health Care . . .

The impact of Gov. George Deukmejian’s health-program vetoes will be felt statewide, but no area will be as hard hit as Los Angeles County, with its disproportionate share of indigent and immigrant populations and the state’s highest AIDS caseload.

Prudent budget construction is, of course, important, and everyone in the state benefits when budgets are constructed to preserve financial integrity and win for California the most favorable bond rating. That saves enormous amounts of money in bond interest. However, the decision of the governor to replenish the reserve to a level of $1.1 billion goes beyond prudence, trading the remote risk of severe economic decline against the real and present and urgent emergency in health services to indigents, deteriorating trauma center networks, inadequate mental-health programs and a shortage of alternative-care AIDS facilities. The veto only postpones doing what must be done, with delay making cost increases inevitable.

The governor and the Legislature will now negotiate on a plan to restore some of the $646 million in cuts. There is room for compromise, evident in the fact that at least one-third of the $157 million that the governor wants restored is for health-related programs, including services for the medically indigent. If his $127-million cut in those services is sustained, Los Angeles County alone will lose at least $40 million, with a crippling impact on a variety of public health services.

The governor also has vetoed supplementary trauma center funds that would have strengthened the system statewide, permitting Los Angeles County to reverse the deterioration of itstrauma system, with the prospect that some of the 10 drop-out hospitals would rejoin.

Deukmejian cited with pride a 32% increase in the overall AIDS spending in 1989-90, despite his $58 million cut. New state support for AIDS actually has been decreased by the governor, although unspent funds from the previous year and increased federal funding will apparently increase the total. The cuts place in jeopardy efforts to establish special residential facilities as alternatives to hospitals because they are both more humane and more cost-effective, and there is also concern that the cuts will hurt efforts to enlarge an early intervention program to extend the lives of those infected with the human immunodeficiency virus (HIV) that causes AIDS.

The crisis in mental-health funding is so severe that several counties have threatened to give up and turn over operations to the state. The veto will mean a gross cut of $10.9 million for Los Angeles County from an already under-funded program. That means that five clinics, kept open half-time temporarily, will be closed Sept. 1. At least two others also will close, and one-third of the money for crisis-management services for the most critical cases will be cut. The situation was summed up for us most succinctly by Francis J. Dowling, chief deputy director of the Los Angeles County Department of Mental Health: “It’s just horrendous.”

The prudence of the governor’s leadership will now be measured, not by an arbitrary reserve, but by a creative use of resources that address the real emergency in the state.