Assemblyman Leland Yee over his term of office as an assemblyman had carried a variety of bills that medicine did not support (including the bill to prohibit physicians from balance billing). Former Assemblyman Lou Papan, while in office for many years, had been a very good friend to medicine and was always on our side on all MICRA challenges. This was a very difficult decision. After the decision was made, we worked to support Mike Nevin’s candidacy, joining with the San Francisco Medical Society to advocate to CMA’s CALPAC on his behalf.

During the primary we also supported the candidacy of Jackie Speier for lieutenant governor. A fund-raiser was organized last fall to support her campaign, and individual doctors supported her candidacy in many ways. Although we didn’t like every piece of legislation she authored or supported, Jackie has had a long history of working with organized medicine, both locally and at the state level.

Interestingly both of these two candidates had a huge cross-section of support from public officials, but in the end neither received enough votes to be elected. I realize members of the House of Medicine do not all support the same candidates, and doctors have different views on the merits and talents of each political leader. But I hope that this particular electoral loss will not deter good leaders like Jackie Speier and Mike Nevin from looking at other opportunities in the political arena. We need the kind of leaders they exemplify.

The county Board of Supervisors currently is reviewing the recommended budget for FY 2006-07 and 2007-08. The budget for FY 2006-07 is projected at $1.59 billion, an increase of $65 million or 4.3 percent. Fortunately next year’s budgeted revenue reflects the strengthening local economy. There has been a growing concern on the part of members of the Board on the cost increases in General Fund contributions to SMMC. In FY 2001-02 the subsidy was $41.8 million. Last year the subsidy was $56.5 million, and the FY 2006-07 recommended amount is $68 million. The $14 million additional subsidy in the coming fiscal year will be provided to SMMC in the form of a loan from the county.

Although this cost is great, it is hard to imagine San Mateo County functioning without SMMC. On any given day there are approximately 40 medical-surgical, 30 psychiatric, and 300 long-term-care patients in SMMC and the Burlingame Long-Term-Care facility, which the county leases. The majority of the $65 million subsidy goes to support about 50 patients per day who are at an appropriate level of care in SMMC and to keep the emergency room open.

The county is legally responsible for medical care for indigent residents. Throughout California, 13 counties out of the 58 counties in California provide care at a county facility, though the county subsidy for SMMC is significantly greater than other Bay Area counties with pubic hospitals, except for San Francisco. The county is considering how to reconceptualize how health care is delivered in the county. It is important for the Medical Association and physicians at large to speak out opposing any direction that would close the hospital. Just imagine the chaos to this community if there were no county hospital.