A down payment on public health

In 1999, Tim Eyman's initiative repealing the motor vehicle excise tax and gutting funding for scores of civic needs, including public health, seemed like a prudent way to trim spendy government.

Fast forward seven years and one has only to look at the state of Washington's public-health system to grasp how a narrowly formed idea came full circle to bite us in the tail.

Public health is drastically underfunded. Spending increases come via federal grants, money with tight strings. The fiscal burden rests on the shoulders of local governments. Thus, public-health-care quality can vary dramatically depending on the county you're in when you're unlucky enough to fall ill.

That's the day-to-day picture. A long-term view isn't much nicer. A major health calamity, such as a SARS outbreak or widespread resistant tuberculosis, could break the system.

State Rep. Shay Schual-Berke, D-Normandy Park, proposes bailing out financially imperiled health clinics and other local health-care programs by inhaling the state cigarette-tax revenue. Most of that money currently goes into the state general fund, save a small amount for anti-smoking programs. The lawmaker wants to reroute the general-fund portion to a dedicated revenue stream and inject $100 million per biennium into public health. (These funds are unrelated to the tobacco-settlement.)

Boy, talk about Sophie's Choice! The general fund would develop a wheezing cough after such a fiscal hit. In an economic downturn, a cough could become pneumonia. Plus, I'm not wild about dedicated funds because they reduce a budget's flexibility. The economy may be healthy right now, but a time could come when feeding children is more important than home visits by nurses.

Doing nothing isn't an option.

Health-care costs continue into the stratosphere accompanied by a rise in uninsured people dependent on public clinics and doctors. To its credit, King County boosted spending on public health from $15.3 million four years ago to $24.5 million last year. Much of the increase was a response to the 160,000 county residents living without health insurance. Even so, a TB outbreak among the county's homeless population strained our public-health system, forcing it to turn to the Centers for Disease Control for assistance.

A good public-health system is one with a strong rapid-response system and enough employees and facilities to meet any threat. It wouldn't take an avian flu pandemic to reveal the strain our system is under.

In the aftermath of the winter storm that left parts of Western Washington in the dark for more than a week, public-health workers had to hit the streets to stem the tide of deaths and serious illnesses from the fumes of charcoal grills and gas-powered generators used to heat homes without electricity.

It was labor-intensive work that couldn't have been done any other way. Many of the vulnerable do not speak English or use mainstream media for information.

All of this is how I have come to see Schual-Berke's admittedly expensive idea in a positive light, with one caveat: Public health cannot take a Pac-Man-sized bite out of the budget this biennium.

The politics of this issue are too large to ignore. Republicans waiting for a savior — can you say Dino Rossi? — would have a field day with a Legislature that pledged $100 million every other year to public health.

Cue the ghost voice announcer on a political ad: "The Democratic Legislature is so wasteful it threw $100 million — that's $100 million — to a special interest."

Schual-Berke, a member of the House Health Care and Wellness Committee and a cardiologist, is no one's fool, so I'm sure none of this is news to her. What might be is my offer of a friendly legislative amendment to HB 1825, scheduled for a House vote this evening: Quarter the bill and watch it sail through.

Start there. The money won't be enough to reform public health in the manner of public-school reform, but it would be a significant start. It could fund pilot programs and save public-health clinics and community initiatives wriggling under the budget knife.

At some point, public health must be dragged into the 21st century. We are a wealthier, better society than one reduced to cowering in the face of pandemic threats or lurching from crisis to crisis. Do it before a repeat of 9/11 or the spread of a nasty virus that arrived aboard a transcontinental flight or a farm animal.

This Legislature ought to begin the work with a sizable down payment.

Lynne K. Varner's column appears regularly on editorial pages of The Times. Her e-mail address is lvarner@seattletimes.com