President's Message: Holding Our Breath!

Page 94 The California Journal of Emergency Medicine IV:4,Nov-Dec 2003 PRESIDENT’s MESSAGE Holding Our Breath! By Paul WIndham, MD, FAAEM CAL/AAEM President California likes to keep its citizens on the edge of their seats, breathless with anticipation of the future. This moment in time is no different. I find myself holding my breath, wondering what will happen in California after the inauguration of our new governor. Governor Davis has just signed legislation that will mandate employer-paid heath insurance for all medium and large businesses. How will Governor Schwarzenegger develop and enforce the rules that will implement that legislation? Who are his lead people on health care issues? Where does he stand on the collapse of the emergency services safety net? How much will we have to educate him? These questions need immediate answers. We’ve been talking about the chronic underfunding of emergency services and the collapse of the safety net for years. The barbarians are no longer at the gates, they have broken down the walls and storming even the citadels of medicine in California. Bakersfield is an especially dramatic example – they’ve already just lost one emergency department to closure, and the county hospital ED has now decided to treat only emergencies. Everyone gets a medical screening exam, but if you don’t meet the EMTALA criteria for severe pain, active labor, or having a condition that’s an immediate threat to life or limb – sorry, we won’t treat your condition? Just imagine the impact this would have on your department, and on your community. Over the years, many ideas to fund the safety net have been floated. Some were frankly stupid, like taxing bullets and beer, and some were smart, like petitioning to get the tobacco settlement money committed to health care. We had no results with the stupid things, and mixed success with the latter. Even when there was an embarrassment of riches in Sacramento, Governor Davis would not allow the commitment of the tobacco money at the state level, although some counties were successful at the local level. The underfunding continues, and with huge budget deficits at the state and federal level, little relief can be expected even from our best friends in politics. It doesn’t matter if Arnold thinks we can walk on water, he still can’t conjure up the $300 million a year we need to fund the system. It is time to go to the people. The ballot initiative is a way to get the people themselves to decide what they expect from emergency services, and what they are willing to pay to have the best system in the world keep running. Such a ballot initiative is in the works. The Emergency Medicine Political Action Committee, EMPAC, is developing the idea with a coalition of other stakeholders, and plans to have it on the ballot next spring. It will take millions of dollars to get that far, and I ask all of you to consider a personal as well as corporate contribution to EMPAC. Send ‘em a check for $500. I did. You can be proud if you do, because you will have helped in perhaps our last good chance to beat back the barbarians. If we don’t act now, we may not have another chance to save our own departments from the fate of Kern County. If this doesn’t work, well, hold your breath. LEGISLATIVE UPDATE (Continued from page 95) the chopping blocks these days as the new governor is considering how to balance his budget. We will need to stay vigilant and vocal to preserve Emergency Care in California. As we prepare to print this CaJEM issue, we heard official news of a Federal Judge blocking the 5% cut, which will certainly then make it even more unlikely for Governor Schwarzenegger will be able to go forward with his planned additional 10% cut in MediCal rates. This again goes to prove how critically we need your contribution to EMPAC. Please give us the tools we need to carry your voice to Sacramento and into practice into your ED. Thank you for your confidence and support.