Health Care/Joan Retsinas

Footnote in Decline of Compassion

The "compassion" in "compassionate conservatism" is vanishing, as we become a nation of "unfortunates."

The people without health insurance are "unfortunate." We just had a national week (May 2-9) to celebrate them (remember?).

People poor enough for government-funded insurance are also unfortunate. States have been trimming their Medicaid budgets. The result: less and lower-quality care for fewer people. Medicare enrollees -- we used to think they were fortunate to get universal insurance -- have watched their overall health tab rise. Even their prescription tab, which was supposed to plummet under a new federal program, is expected to rise. How unfortunate!

This misfortune is not an act of nature, but of government. Our legislators control the spigots that give help to people. And voters ultimately control those legislators.

Voters have said no to turning on the spigots. Voters want tax cuts, not tax increases. When legislators have opened the spigots too profligately, voters have stanched the flow with initiatives: In 1978 California voters passed Proposition 13, which limited property taxes. That California initiative sparked similar propositions throughout the country, as constituents capped their solons' zeal-to-spend.

The reluctance to spend transcends income and ideology. Wealthy conservatives in Congress pressed for the president's tax cuts. But it is not just the wealthy who abhor taxes. Consider Alabama. In 2003, when Gov. Bob Riley pressed his Bible Belt constituents to raise taxes, citing religious admonitions to help the poor (there are a lot of them in Alabama), the voters (two to one) said no.

So California deserves a footnote -- maybe a chapter -- in the history of the decline of compassion.

Last November California voters approved Proposition 63, which raises taxes on the wealthiest 0.1% of taxpayers. The approximately 30,000 Californians who earn over $1 million a year will pay an extra 1% tax toward mental health services. The measure is expected to add $275 million to the state's mental health budget this year, and $800 million in future years. Wisely, Proposition 63 limited the percentage of money that could go to administration and barred the state from transferring those added revenues away from mental health. (In a budget-crunch, compassion for the mentally ill might fall by the wayside, as legislators seize the money to balance their budgets. That happened with tobacco windfall money, which in many states vanished into the black hole of budget deficits). Wisely too, Proposition 63 barred the state from reducing its mental health commitment below 2003-04 levels. Otherwise, the initiative money would simply replace state money.

The arguments for the initiative called upon cost-benefit reasoning; i.e., if we spend more on mental health, we will save on corrections and social services. We will reduce the number of homeless living on the street.

Arguments for spending social service money generally follow that motif: If we help people, the government will ultimately save money. The arguments also called upon compassion: The mentally ill need help, and the state has been cutting back those programs until the safety net is illusory. People won't get better without help.

This time the arguments worked. A majority (53.8%) of Californians said yes to the tax levy. Richard Scheffler from the University of California Berkeley and Neal Adams from the California Institute of Mental Health have dissected the election returns. Health Affairs has published an analysis of the vote on its Web site.

Counties with more Democrats, more social workers per capita and higher rates of homelessness were more likely to vote "yes." Three-quarters of San Franciscans voted "yes." The researchers note the tepid opposition. Not only did the media, along with a host of community organizations, support Proposition 63, but Gov. Schwarzenegger, who did not support it, did not actively campaign against it. (He campaigned against a companion Proposition 72, which would have required employers to insure more workers. That failed, but only by 0.9%.) Proposition 63 supporters raised $4.3 million; opponents, $17,500.

Maybe compassion is resurfacing. We'll see whether other states pass initiatives that raise taxes to help the unfortunates -- a growing cadre -- among us. Meanwhile, the tale of Proposition 63 marks a happy moment in a decade of voter stinginess.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

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