State budget proposal puts people at risk

Gov. Gary Locke has drawn accolades from conservatives for a budget that slashes programs and raises no major taxes. But we should all be aware that under his proposal, some of Washington's weakest and most vulnerable citizens may die.

Most people understand that the governor's December budget is never the Legislature's springtime "go-home budget." It does, however, set the stage for the state's biennial debate. Governors often squander this leadership opportunity. At least in terms of health care, Locke did not.

It is a tough call to make if accepting human misery is the price for balancing the budget. Such action is not only socially unjust but, in the long term, fiscally unsound. Difficult as it may have been, discussing revenue increases at the same time as spending priorities would have been the right thing to do.

The governor's much-touted "Priorities of Government" exercise produced more than fodder for policy wonks; it answered a basic question. In the health care arena, Locke settled on the correct answer that maintaining and improving the health of Washingtonians should be our top priority. To meet this goal, we must do the following: rebuild our state's sorely neglected public health infrastructure.

We need to ensure safe food, uncontaminated water, breathable air and infectious disease surveillance and control. Included here is emergency health and bioterrorism response preparedness, as well as attacking the leading causes of premature death -- tobacco use, alcohol and chemical dependency, sedentary lifestyles and unhealthy diets -- through health education, incentives and community partnerships that promote personal responsibility.

Rebuild all of this even before reversing the flight of doctors and nurses from a faltering medical care system, and before maintaining insurance coverage for thousands who cannot afford it.

Privately, most health professionals agree that maintaining and improving the health of Washingtonians should be our first priority -- unless you ask them with a budget ax in your hand. But setting good priorities is not the same as having enough to go around. No amount of smart policy talk (or private markets demagoguery for that matter) can get around the simple fact that the state is the largest, single medical purchaser for residents. In fact, the state underwrites care for about one in four of us.

Still, there is little doubt that Locke's unwillingness or inability to propose an adequate revenue base for state government will cause citizens' health to suffer. Thousands of children could fail at school because they will be too sick to learn. Chronically ill people will begin to quietly and prematurely die at home for want of community health services. With private employers and the state both reducing health care coverage, thousands of underinsured working adults will be forced to trickle into hospital emergency rooms, needlessly sick and unable to work for want of primary and preventative medical care. Even more tragically, serious illness will result in the loss of homes and college tuition savings to increasing medical debts.

There is also little doubt that health care providers will quietly throw in the towel on serving the poor and disabled, rather than continuing to lose money because of paltry state and federal reimbursement rates.

So, why did Locke take such drastic action?

He knows that the state's constitutional duties to protect public health and its role as health care provider of last resort consume state resources at a level that is second only to education. And he sees state health care costs soaring from an increasingly, chronically ill population and from buying medical miracles for only a few. At the same time, the inappropriately escalating consumer demand for marginally useful prescription drugs and questionable diagnostic health care services must be added to the exploding cost of health care.

Locke knows that only a few pennies of our state health care dollar now go for proven public health and preventative services. He is right to be dismayed that health care costs are eating up state resources at unsustainable rates.

The governor is right to set health spending priorities, and he is right to say we cannot afford to do it all. But in setting the rules of his "Priorities of Government" budget, Locke established a "No New Taxes" dictum. This policy means a health care cut. Without significant public outcry that forces legislative modifications in the state budget, health care cuts will kill some of us, and that should shame all of us.

Citizens are urged to call their legislators at 1-800-562-6000.

Peter McGough and John Moyer are members of the Rainier Institute, a non-profit, bi-partisan think tank; www.rainierinstitute.com Moyer was a Republican state senator and representative from Spokane. McGough is medical director of University of Washington Physicians Network Clinic in Factoria. Also contributing to the article was Dr. Maggie Baker, on the faculty at the UW School of Nursing and a former health care administrator at Ohio State University.

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