Do you care who runs California's lottery? Would you mind if Blue Cross or some other HMO provided care in the state's prisons? Do you have feelings for (or understand) the Williamson Act or the State Compensation Insurance Fund?

Those were some of the ways mentioned to two-dozen Central California hospital officials April 25 by Assembly Minority Leader Mike Villines of Clovis as he puzzled how legislators may tackle the state's multi-billion-dollar budget deficit.

Although little coherence seems evident in Sacramento, the hammer, the ax, the Big Hurt, the cutting of "meat and bones" as one Valley clinic CEO put it -- is coming.

Ten percent across the board is what's on the table. Some of these cuts, including Medi-Cal, would involve turning away matching federal money -- a double-whammy that Villines said lawmakers would like to avoid. The California Hospital Association reports that the state's community hospitals -- like Fresno-based Community Medical Centers -- lose 22 cents for every dollar of cost incurred for treating Medi-Cal patients. Another 10% cut, the association says, would mean more patients seeking care in emergency rooms and more closures of fiscally strapped ERs.

There's no time for deep reflection, Villines said, this is a horse race. The budget deadline is July 1, a line frequently crossed. But the hole is deepening. As of April 28, two-year deficit projections of $18 billion were being floated. 

Over the years, experts have cautioned that the only way health care will be significantly improved is if something unfortunate happens to somebody important. A dire thought. The health "system" in Los Angeles has been hemorrhaging to death for decades. It now has numerous mirror images elsewhere.

"Fear will drive change," Villines said, referring to what might spur legislators.  Replace the word "change" with "improvement" -- and I'd be OK with some more belt-tightening.