Clinic Cutbacks Jeopardize Public Health: By MARC SAPIR

Tuesday August 10, 2004

On Aug. 3, about 120 staff from the remaining three county community medical clinics in Newark, Hayward and Oakland walked off the job and confronted the Alameda County Board of Supervisors. The supervisors were holding a retreat in an off-site location and the workers let them know what they think of planned new and deep cuts in staffing and services for the public. At that event I handed the following letter to each member of the board individually. 



An Open Letter to Supervisors Nate Miley and Keith Carson: 


I have worked intermittently as a physician in Alameda County’s community clinics since 1988. I currently work one to two days a week in those clinics. I have known both of you off and on since before you became members of the Alameda County Board of Supervisors. My contacts with each of you have occurred both before and during my tenure as medical director of the Center for Elders’ Independence (1992-2001). I have observed that during the time that you both have been active in local politics, calling yourselves liberals and representatives of the community’s interests, you have not done enough to prevent the decay and destruction of the public health and public medical care system in this county. The survival of Highland Hospital, which both of you have on paper supported, has consistently been jeopardized by your ongoing failure to remove Health Director David Kears, a brilliant man who has protected his own position to sacrifice the public—from the time of the Two Plan to the formation of the Hospital Board to the separation of the Community Clinics from the Public Health Department. I know Mr. Kears. He is talented, but disingenuous. He has never been a sufficiently strong advocate for the public’s health interests to have held this position for so many years. He has maneuvered successfully and weakened this county’s health care system. 

When ACMC Board decided to close Central Health Center and Fairmont’s clinics last year I warned anyone who would listen that if you cut off your strong arms, you will never be able to defend yourself from wolves. I predicted the closing of Highland Hospital in three years if there was not a sufficiently strong fight to prevent clinic closures and cutbacks. SEIU did not take that fight seriously enough then. The public should be thankful that SEIU and its members now seem to be taking the fight more seriously. The earlier closures led only to an increase in the deficit which any 9th grade mathematician could have predicted. Now you are on the verge of permitting an action—the layoff of hundreds of staff—that will decimate what remains of the system. Morale and functionality, already problems, will worsen and nothing will be accomplished on the financial side until you have limited the public’s access to care so severely that immense suffering will be engendered. Cuts in services are not acceptable in a time of economic crisis.  

I am not a fan of capitalism, but I will tell you something about it that you may not remember. During the Great Depression a Democrat who believed in capitalism named Franklin Roosevelt faced extreme economic conditions with little resources for government and a looming war. He did not shun the challenge to the public and welfare role of government. Instead of shrinking public government, he dramatically and successfully expanded it. With the backing of millions of organized Americans he put into place almost all of the government support programs we take for granted over the past 60 years. Yes, the federal government has the power to borrow and print money that local governments do not have. That is significant. The current Washington regime and even the Democrats in the national picture also are obstacles to expansion of public government in the interests of people who need care, housing, supportive services. But the buck on ACMC stops with you not with Washington. If you are going to play the role of disciplining the public, the workers, the poor for the sins of this system, for the wars, depredations and expansionism of the market system then you had best stop thinking of yourselves as advocates for the people who elect you. If you can not stand firm and hold the line on at least minimum services in health care, then get out of the way and let people who will fight take your places. Caring isn’t enough. You have to take your stand. We all worked with you to pass Measure A for the board and for the public. And we are being repaid with more of the same crap. Enough blood is on the floor. 


Marc Sapir MD, MPH is a practicing physician, a former health officer, and the executive director of www.retropoll.org.?