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Voices From The Nursing School By Kristina Hung With the Governor’s proposed budget cuts, one has to wonder if he has long-term vision for the state. How can he ignore the glaring evidence that California’s economics is intricately entwined with the healthcare and educational services that are ultimately being cut? As a nursing student, I have become acutely aware of the social determinants of health and increasingly concerned with what little is being done to address the root causes of the health issues that plague our state. If we are to make a lasting impact, we need to focus on preventing the negative health outcomes before they happen, instead of further chipping away at the already weak safety net that we have in place. As Americans, we want to see immediate results, but if we are to truly see change in the long-term, we need to build a healthcare infrastructure that not only addresses the problems at hand, but also goes upstream and addresses the sources of the problems. A recent series on PBS called Unnatural Causes: Is Inequality Making Us Sick? shows how income and education are among the highest predictors of health outcomes and infant mortality. The recent budget cuts are like putting a Band-Aid on an infected wound, without addressing the source of the infection. By cutting the payment to Medi-Cal providers by 10 percent, accounting for over $1.3 billion in loss of funds according to the California Budget Project, in addition to the $4.4 billion being cut from public schools, the Governor is weakening the safety net and hurting those without the funds for private education and without the type of job that provides private health insurance. It is ironic that he will go to such lengths to save money, when his actions will cause a more drastic financial crisis in the future. When preventative services are removed from the poor, they end up in emergency departments and hospitals. My husband was admitted to the ED a few weeks ago, and the cost of a couple hours of IV hydration and some lab tests was well over $3,000. Emergency services are costly. When the poor are limited to emergency services, it costs much more than the initial preventative care would have. I recently went on a home health visit with a public health nurse and was impressed by the completeness of the assessments and interventions that were done in a single visit. The nurse efficiently addressed everything from relevant disease issues, to domestic violence, nutrition, employment, safety in the home, breastfeeding, needs for food, health insurance coverage, as well as mold and other asthma-triggering antigens in the home. The education done by these nurses has prevented many from reaching dire situations. These nurses are addressing the root causes of issues before they flourish into more serious emergencies and fatalities. However, these preventative healthcare positions are being threatened by the budget cuts and may soon disappear since they are not part of the mandated nurse-patient ratios that exist in the hospital. San Francisco is looking to lose 30 percent of its home health care program for Medi-Cal patients. As the state makes sweeping cuts, the services that are thrown out are the ones that appear the easiest to cut upfront, even if the long-term consequences are costly. As healthcare professionals we need to look at the bigger picture and fight for Californians. Although it is easier for those in government to try a quick Band-Aid solution, we need to take responsibility to make others aware of how education, economics, and health are so closely linked, and will affect the economic outcome of California positively or negatively depending on how each is addressed. As people who care about the health disparities in this city, we need to become unified in our concern over cutting preventative services to the poor. Although it may not be as glamorous and exciting as the emergency department, focusing on preventing people from ever getting there will save money and lives, and bring about a better quality of life for everyone. Kristina Hung is a MEPN student in the School of Nursing.
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