Failing Health

Efforts to reduce government spending in Washington, in Sacramento and at the county level have created a new crisis in health care for low-income Americans, and the problem is going to get much worse next year unless there are prompt changes in federal and state budgets. The situation is all the more ominous because most of the areas of neglect will contribute to much higher expenses at a later date as untreated health problems become more intractable.

The most serious problems in California are these:

--Declining pre-natal service to Medi-Cal patients as obstetricians withdraw from the program. Thousands of women are being denied medical service in the first trimester of their pregnancies despite the proven effectiveness of this service in reducing costly complications.

--Declining utilization of children’s dental services under Medi-Cal despite the evidence of dental-disease prevalence in this group. As with pre-natal services, many general dentists and most specialists are refusing to participate in the program.

--Declining hospital services to indigent adults as funding falls behind the growing need.

The problems will be exacerbated if President Reagan implements his plan to terminate revenue sharing on Oct. 1. Those federal funds provide $100 million a year directly to health-care operations in California.

Paradoxically, there is no dispute among officials as to the cost-effectiveness, proven usefulness and importance to society as a whole of the basic health services now in jeopardy. Many doctors assert that no health-care dollars are more productive than those spent on monitoring the first three months of pregnancy. High-risk children, whose teeth are neglected in the early years, ultimately face far costlier treatments. Inadequate basic hospital and clinic services for the indigent also contribute in the long run to greatly inflated health-care costs as diseases develop and become more complex.

But these rational arguments do not appear to sway government leaders and legislators who have been persuaded that their first priority is reducing budget outlays this year, even at the price of increasing costs in the future.

At the state level, Gov. George Deukmejian took the initiative last year to address the crisis for hospitals caring for the indigent. He added $50 million. In the months since, the hospitals have reported that the money was not adequate to permit them to increase access to care, but in major centers, such as Los Angeles County, the additional funds at least circumvented a cutback in services. The governor has offered no increase in those funds this year, but his innovative contribution last year has encouraged some in the health-care field to be optimistic that he will respond again. So he should.

Also at the state level, the governor’s staff is considering increments in obstetricians’ fees under Medi-Cal to try to restore the pre-natal program. In some areas entire counties are without obstetricians willing to accept new Medi-Cal patients. The reluctance of the obstetricians is understandable. The Medi-Cal fees are woefully inadequate, and the doctors themselves face rapidly rising malpractice insurance costs, now averaging $40,000 a year--the highest for any medical specialty.

A fee adjustment for obstetricians would not resolve the problem for dentists, however. And Medi-Cal fees to dentists generally are even lower than fees for physicians--averaging about 40% of usual charges. State officials assert that there is not enough money to pay appropriate and adequate fees. There has been a modest move to simplify the paperwork, but it does not appear sufficient to win the participation of more dentists.

The programs are short of federal funds because of the slashes being made by leaders who refuse to raise taxes to help reduce the deficit. The resistance to higher taxes on the part of national and state leaders will prove to be a vote-winning policy only so long as the real costs of inadequate health services are concealed. The question that needs to be answered is not whether the nation can afford the cost of these programs today but, rather, whether the nation can afford the much higher cost tomorrow that is inherent in today’s neglect of proper health care.