Each month this year, KQED Public Radio's The California Report is hosting special statewide live discussions of health issues of importance to Californians.  More than a dozen public radio stations statewide air these informative sessions, and many of them have added local programming of their own to this special project.

In February, the discussion focused on Communities Helping Themselves.  Program guests included Dr. Mitchell Katz, Director of Health in the San Francisco Department of Public Health; Belma Gonzalez, Program Coordinator for Women's Choices; Lori Juszak, Executive Director of Grassroots for Kids; and Dr. Michael Cousineau, Associate Professor of Family Medicine at the USC Keck School of Medicine.  Our special broadcast is part of Health Dialogues, an ambitious two-year special effort to look at California health issues, funded by The California Endowment.

As a California civic and legislative leader, you have made a commitment to examining and addressing health issues.  We thought you would want to hear a few of the comments, summarized below, made by callers some of whom are your constituents.  I am also enclosing a compact disc recording of the entire program in case you or your staff might wish to hear the conversation in context.

Here are some of the issues that surfaced during the program, which we think can be further illuminated with your ideas, suggestions and comments:

1. Mary in San Francisco said she has spent much time in San Francisco General Hospital waiting rooms as a patient, often alongside others who did not speak English.  At times, she said, people unable to communicate with staff members created unpleasant "scenes."  In your view, what can policymakers do to improve foreign language services in the state health care system?
2. Two other callers, Steve in Moraga and Bob in Salinas, expressed concern about Medi-Cal's financial viability.  Up-front charges like co-pays can preserve the program by preventing injudicious use of medical services, they observed.  But unless  "out-of-pocket" payments are used to curtail Medi-Cal costs, California will need to raise much more money to keep the safety net functioning.  It would seem to be a choice between raising taxes or cutting services.  What would you advocate?
3. Maria, who works in a San Diego neighborhood with many environmental health problems, said asthma prevalence there is twice the national average.  When community health educators successfully pushed for heavy metals testing, they found that a house located between two factories that use cancer-causing chromium had high levels of the metal, yet the county health department insisted on a third round of testing before taking any action.  How can the state legislature help communities like hers hold health officials accountable for their environmental health policies?
4. For Osmund in San Diego, Medi-Cal won't truly be serving the people without funding for transportation.  Having health insurance doesn't help those unable to get to the doctor, he noted.  This would seem especially true in cities that don't have good public transit systems and even worse in rural areas. Given this, how can legislators help give people true access to health care including transportation?
5. A number of callers pointed at signs that the health care safety net is poorly funded:
   • According to Steve, a physician at San Francisco General Hospital who has spent time in Mexico, public hospitals have lost so much funding, that we are nearing Third World conditions.
   • Another concern expressed was that children are not getting dental services because of low Denti-Cal reimbursements. Lori Juszack of Shingletown's Grassroots for Kids, said she doesn't know of a single orthodontist between Sacramento and Oregon who can afford to take on new Denti-Cal patients in medical need of braces.  And patients face similar problems in general dentistry -- even in cities.
   • Pat in Trinity County, who works for a physician who opened up a rural community health clinic, said Medi-Cal hasn't reimbursed him for his services in three years.
   What would you tell these citizens about how the state could respond to the apparent underfunding of public health services and the slow rate of Medi-Cal reimbursements?

These comments, along with other information about the program and the issue, will soon be available on our web site.  We would be pleased to be able to add your observations to our web site -- particularly any responses to the questions above.  I invite you to join this lively discussion.

The aim of Health Dialogues is to facilitate a statewide discussion on important health issues -- a conversation that brings to the table (on air and via the World Wide Web) policy makers, state officials, private sector organizations, non-profits and everyday citizens affected by health issues and policies.  We believe that your observations and ideas would enrich that conversation.

Sincerely,

Raul Ramirez, Director
News and Public Affairs
KQED Public Radio