I would never have imagined that I would write this headline in Orange County, California. Long considered a conservative-republican bastion, it flies in the face of all that is conservative to have the “government” involved in the health care conversations between a patient and their doctor. But that is exactly what the Orange County Board of Supervisors is set to consider on Tuesday. All this because Supervisor John Moorlach has this desire to shoot flies with a shotgun.
After failing to find a legal way to terminate the portion of a community clinic grant funded with Tobacco Settlement Revenues (TSR) for education and outreach such as comprehensive reproductive health because it went to a Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) clinic in Orange, the Health Care Agency (HCA) has come forward with a compromise designed to get the Board out of hot water. The compromise is needed since their decision to suspend the PPOSBC subcontract performs abortion services ignores the fact that the same education programs are delivered by other organizations receiving the same funding.
The proposal from HCA is to rescind the decision to suspend the portion of the contract awarded to PPOSBC that expires on June 30, 2009. In addition, staff recommends that the Board to establish new policies regarding the expenditure of TSR for community clinics. The new policy restricts community clinic uses of TSR to direct medical, mental health, and dental services. The staff recommendation states; “This would exclude the following types of services for which TSR funds are now used.Â
- Health education activities, including family planning education, at the Laguna Beach Community Clinic, Orange County Rescue Mission, Planned Parenthood, and Vietnamese Community of Orange County Clinic. Education as part of direct clinical services, such as treatment of diabetes or hypertension, would still be permitted: however group information programs, health education classes, or group education activities including media productions and publications would not be permitted to be funded with community clinic TSR.
- Language translation services at UCI clinics, except as part of direct services.”
The LiberalOC has requested clarification as to what this means exactly, but based upon our initial review it looks like they are proposing to cut any form of family planning education by eliminating funding for all health education programs. The first problem I can see here is what if we have a woman present for clinical services who is pregnant and wants information about her options related to her pregnancy? Is that covered under “direct clinical services” exception?
The answer seems to lie a little later in the staff recommendation. HCA proposes that the policy “Prohibit any use of community clinic TSR for abortions, abortion referrals, abortion counseling, or promotion or advocacy of abortion as a method of family planning.” HCA further recommends that if a clinic receives community clinic TSR and elects to engage in any such activities that the clinic would “be required to physically and financially separate them from any activities funded by community clinic TSR.”
Using the example of a patient seeking family planning options, the only way they would be able to get this information would be if they went to a completely separate clinic which does not receive community clinic TSR funding. The catch; since the clinic cannot provide any referral information or counseling that included the topic of abortion the doctor cannot tell the patient where to get any information. Further, they would not even be able to have a brochure on hand to provide the client with that information in written form. This is a gag order, similar to ones attached to global HIV preventions efforts funded by the United States by the Bush administration. In that case, the message of condom use as a means of disease prevention was prevented in clinics receiving funds and if the clinic received funds, they could not provide any information, referral, or abortion related services.
The implication of this policy is much broader than one might expect. If approved, all community clinics receiving community clinic TSR would have to purge their clinics of any and all family planning information and programs from their facilities. The price of receiving the TSR funds would be to cease to provide factual and complete information to clients about their reproductive health options. This flies in the face of health care best practices and the responsibility of doctors to provide full and complete information to their clients so that they can make informed decisions.
The traditional Republican battle cry in opposition to any form of national health care reform has been “No Socialized Medicine!” Their other common refrain is “health care decisions should be made by doctors and their patients, not by the government.” Well, medical care dictated by the government is exactly where this proposal takes us.
The Orange County Register’s Jennifer Muir reports that Supervisor Moorlach is throwing a hissy-fit over the recommendation to rescind the previous action to suspend the Planned Parenthood subcontract through the end of the year. You should check out her take when you’re done here.
While HCA should be commended for drafting a possible solution, their efforts were hindered by having to propose rules to address a nonexistent problem. TSR funds have never been used to support or provide abortion services. While not the best public policy course, there is a better way to accomplish Moorlach’s desire to eliminate the funding for the health education programs the he doesn’t like. Dedicate the funding to clinical services and permit health education if it is directly related to clinical care. There is no compelling public need to restrict what community clinics do with other funding they receive. Government should not have to police what is done with nongovernment funds.
Unfortunately, it looks like Supervisor’s John Moorlach and Bill Campbell would rather shoot at flies with a shotgun; destroying valid and important health education activities and tell doctors what they may tell their patients when delivering care.
I think that is called “Politically Socialized Medicine.”