The politics of who will pay for California’s health care reform got a front row seat at Western University of Health Sciences in Pomona Friday.

The first of two symposiums, organized by Western University and Assemblyman Mervyn Dymally, D-Compton, focused on health care financing, and the uphill battle

facing lawmakers and Governor Arnold Schwarzenegger’s bid to bring universal health care to California.

"One key to looking at health care is to realize the statistics represent individuals, not merely numbers," Western University president Phillip Pumerantz told a group of  the state’s most powerful players – doctors, insurers, academics, business and hospital leaders. 

Less than a month after Schwarzenegger called lawmakers into a special session to deal with a health care solution for 6.7 million uninsured Californians, Dymally the chair of Assembly Health Committee told listeners "disastrous political ideology" has all but trumped hopes of reaching a consensus over how to pay for it.

"The prospects for a reform bill look very dim," said Dymally, "They (Republicans) want to play. But they don’t want to pay."         

Dymally said despite a compromise on expansion of state supported medical clinics and increased compensation for Medi-Cal doctors (the lowest reimbursement in the nation) Democrats lack the two-thirds majority vote needed to pass any measure.  

"Republicans have taken the position that they will not vote for any tax increase. Without money – the prospects for giving Californians a health care reform package looks bleak."

Schwarzenegger, who vowed in last year’s campaign to resist tax increases, has suggested that he and the lawmakers should enact the outlines of a plan but leave the financing – i.e. the tax increases – to a ballot initiative. However, to be approved in the Legislature alone, most fees would require at least eight Republicans lawmakers to support the plan. Republican legislators have opposed any such new charges on businesses, hospitals or doctors.

"With the Republicans unwilling to budge on funding, and no legislative proposal on the table," Dymally told listeners, lawmakers are literally at "home on call." 

"People ask me ‘what’s different, what’s the problem, Californians want a health plan,’ my answer is without a doubt, partisanship. A climate of very, very unfortunate ideology has swept California."

Dymally said lawmakers are organized into working groups to focus on water and health care. When agreements are reached, he said policy committees will be called in and eventually all of the Assembly.

Given the national fanfare that accompanied the governor’s reform plan, and the sense that this non-election year may afford a narrow window of opportunity, some experts say failure in California may arrest the national momentum behind health care reform.

Symposium presenter Jim Lott, Executive Vice President, Hospital Association of Southern California highlighted another wrinkle in the health care debate: closing hospitals, over burdened emergency departments and a severe shortage of healthcare professionals.

 "We’re sitting on a time bomb."  Lott says of the nearly 80 hospitals including 36 emergency departments closed in California between 1996 and 2000.

"The average age of a registered nurse working in a hospital is 48, and nurses tend to retire around age 55, he said. For every three nurses that are retiring, only one new nurse is graduating."

"It’s a recipe for disaster, we need to double that," said Lott.

Dr. James M. Lally, Western alumni, president and chief medical officer for Chino Valley Medical Center, said one important method of easing the emergency room burden is treating patients before they require emergency care. Lally says the Montclair facility  treats an average of 35 non paying patients per day.

"By taking that extra step, we’re able to divert some of those people out of our emergency room."

Dr. Susan Kelly, president and CEO of Charles Drew University told listeners  the August closure of Martin Luther King-Harbor Hospital combined with the loss of critical physician training programs literally chocks off the supply of primary care physicians willing to serve in medically underserved communities.

"It’s disastrous, the south Los Angeles area has a population of 1.6 million people, with only one hospital operating in the community – Saint Francis Medical Center.

It’s the largest urban underserved community in America said Kelly "This is not an accident. This is an area that is not so much neglected as constructively abandoned."

She said the closure resulted in the loss of 248 physician residency slots across 17 resident programs and the loss of 28 emergency room doctors 26 of which left the state, maybe forever, she said.

"Residents in other areas such as the Inland Empire might think the closure doesn’t affect them, but they are wrong. This is not a localized impact. South Los Angeles patients travel to surrounding cities for medical care, increasing wait times in those areas."

The panel agreed failure to address California’s complex health care crisis will have the effect of throwing a wet blanket on the national debate. 

California is in the national spotlight to tackle this most prickly of domestic issues added Dymally. "We have to believe that anything is possible – Successful health care legislation in California would ultimately inspire the rest of the nation to follow our lead."