Lawmakers Hand Reins to the Voters

The November ballot should be enshrined in history. Not because of the quality -- or lack thereof -- of the candidates it features. Rather, this particular ballot is notable because it so perfectly illustrates the decline of California government. Only such a deterioration explains the presence on the ballot of three measures to be decided by voters scarcely aware of the complexities and unintended consequences of the choices they will make.

These are issues that should have been settled years ago by lawmakers who were elected to do such work. But restricted by deficits and Proposition 13, their careers unstable because of term limits, and obsessed with raising money, elected officials have abandoned the battlefield.

There is Proposition 49, backed by action-movie star Arnold Schwarzenegger, which would require the state to spend $550 million a year from the general fund for after-school programs in elementary, middle and junior high schools. The programs would include tutoring, computer training, fine arts and physical fitness activities.

There is Proposition 51, which would vastly increase the amount of money from the state motor vehicle sales tax spent on mass transit, highways and streets, school buses and the environment. This would be done by dedicating 30% of the motor vehicle tax proceeds to these causes. This would remove money from the general fund, where it is now used to finance education, social services, health care, prisons and a variety of other state programs.

And there is Los Angeles County Measure B, conceived by Los Angeles County Supervisor Zev Yaroslavsky, which proposes raising $175 million a year to support the county’s financially strapped and shrinking network of trauma centers, which care for the most seriously injured emergency patients. The money would come from a 3-cent-a-square-foot tax on developed property. Although Measure B is limited to Los Angeles County, it results from the failure of federal, state and county governments to provide health care to the uninsured, who consequently wind up in county hospitals -- the care centers of last resort. This huge patient load has drained the public health systems in Los Angeles and other urban counties of funds. Now, Los Angeles County is threatening to close hospitals as well as trauma centers.

These three measures demonstrate the bizarre way in which taxpayer dollars are allocated these days: The best campaign wins. It matters little whether a cause is good or bad, only how its ads play with voters. Advertising is as close as we come these days to political debate.

In the case of Measure B, doctors at the county’s Harbor-UCLA Medical Center have hired political consultant Douglas Jeffe to help them focus their message in order to compete in the new-style ballot battles. Although Harbor’s utilitarian facility is not in an upscale neighborhood and serves a mostly working-class clientele, a group of doctors there has reached out to business, labor and community leaders to form the Harbor-UCLA Community Alliance.

The group’s political efforts are not aimed at the patients served by the hospital as much as at the more affluent, more-likely-to-vote residents of the beach cities, the Palos Verdes Peninsula, Torrance and other middle-class and upper-middle-class areas in the South Bay. The carefully crafted message being sent by the group is that preserving the trauma center could save the life of a Palos Verdes resident after a Harbor Freeway car crash.

Refocusing the issue toward more affluent voters has obvious political advantages. But it misses the root causes of the health crisis. “The story is the profound underfunding that has gone on for years and has finally caught up with us,” said Dr. Gail Anderson Jr., the hospital’s medical director. In Harbor’s emergency room on a recent afternoon, it appeared Anderson had the story right. Patients filled every seat in the waiting room and all the examining rooms. By evening, the sick would be seated on the waiting-room floor and gurneys, with patients stacked up in hallways and the middle of the emergency room. On busy days, the staff says, patients can wait eight hours for care.

Some of the patients are brought in after overdosing on drugs or alcohol or with gunshot wounds. Along with such cases are the uninsured who show up at the emergency ward when their illnesses become too severe to ignore.

There was a time when legislators would have spent time in such wards studying the problems. Then, with the assistance of experienced consultants, they would have dealt with the problem of the uninsured instead of passing the buck to the voters, who don’t have the expertise to know what the best solution is. It’s true that the old legislatures had plenty of crooks, drunks and eccentrics. But the legislators weren’t afraid to take on -- and conquer -- seemingly insoluble problems.

And this isn’t from the musty old memory of an ex-legislative reporter. Working on a biography of Jesse M. Unruh, the late California political leader, I have been researching our state Legislature’s work on improving care for the mentally ill during the late 1950s and 1960s.

Recently, I drove up to the Placerville area of Northern California and interviewed a central figure in that reform, Jerome R. Waldie, a former congressman and state assemblyman. The ‘50s were still the “snake pit” era, and legislators, spurred on by relatives of patients, wanted to close the huge warehouse state mental hospitals, replacing them with something better. Waldie, who had been active on legislation to help mentally impaired children, was asked by Unruh to head a subcommittee to investigate care of the mentally ill, particularly in the hospitals.

A consultant, Arthur Bolton, prepared a 30-page questionnaire for hospital officials. Waldie and his colleagues analyzed the answers for two months and then held two months of hearings before a subcommittee composed of legislators who knew the issue. Legislators also visited facilities around the state. “After a tour, you didn’t want to do much else except cry,” Waldie said.

Waldie moved on to Congress, but the other subcommittee members -- Frank Lanterman of La Canada-Flintridge and Nicholas Petris of Oakland, along with state Sen. Alan Short of Stockton -- drafted legislation designed to shift huge numbers of the mentally ill from hospitals to community care. The plans were ambitious and could have transformed care for the mentally ill had Gov. Ronald Reagan and his successors not starved the program. Most of the community facilities were never built, and the homeless mentally ill are now our constant companions on city streets. But that wasn’t the fault of the lawmakers who did the hard work and took the political risks to help a powerless segment of society.

Contrast that with the experience of Rob Reiner, the actor and filmmaker, when in the 1990s he became interested in programs to promote health, education, child care and other programs for expectant parents and children under 5. He encountered indifference in Washington, Sacramento and other state capitals. There were no lobbyists for this particular segment of society, he found, nor were there campaign contributions.

But he had celebrity, connections and the ability to attract a cadre of skilled political advisors. Against the heavily funded efforts of tobacco companies, the Reiner team persuaded voters to approve Proposition 10 in 1998, raising the cigarette tax by 50 cents a pack. The tax has meant more than $600 million a year for children’s programs. Part of the money is spent by a state commission and part by commissions in each of the state’s 58 counties. The Los Angeles County Proposition 10 Commission has approved two major programs. One would allocate $100 million over five years to improve health insurance coverage for children. The other would spend $100 million to begin providing free full-day preschool for every child in the county.

These are excellent ideas, but they should have been studied, debated and improved in the Legislature. They should have been considered alongside other funding needs. But failing that, someone had to step in. Reiner deserves a place in history, along with this year’s ballot. Knowing Sacramento didn’t care, he had to find a source of funding -- the cigarette tax increase. He did it himself. So did Schwarzenegger, fighting for a cause or trying to start a campaign for governor. So did Yaroslavsky, rebuffed in his efforts in Los Angeles, Sacramento and Washington to save the public health-care system.

It’s a mess. But that’s California government today.