When cages are rattled, who yells loudest and who gets attention? The perennial debate over shriveling California resources -- worse this year because of a $17 billion-plus budget deficit -- may boil down to a food fight pitting health care vs. education vs. prisons. And the courts may play a key role.

Last week, I was one of nine Valley health care reps explaining to state Senate minority leader Dave Cogdill of Modesto what might happen to health care and the local economy if the Legislature enacts multi-million-dollar Medi-Cal and other cuts. (A few weeks back, the Hospital Council of Northern and Central California took this message to Assembly minority leader Mike Villines of Clovis.)

Sequoia is already laying off clinic staff, he was told. Sierra Kings Hospital in Reedley could foresee closure. Adult day care at St. Agnes is at risk. Ambulance companies are driving on red ink. Community Medical Centers is flooded with patients now; if others downsize, they'll head our way. And I reminded him that the American Hospital Association estimates that each hospital job in California supports another 2.5 jobs in the community.

Cogdill, a soft-spoken man who measures his words, has heard these cautions and entreaties before. Your best hope, he said, is that courts rule in favor of health care providers who've filed suit to halt the Medi-Cal reductions. Then he cautioned that federal courts, who are overseeing state prison reform, could directly tap state coffers for the multi-billion-dollar reforms need to care for growing and increasingly aging inmate populations.

And the teachers union has a lock on the Democratic majority, said Cogdill, a Republican. It objects to any budget cuts.

People don't see the connection, he said, that if you more fully fund teachers or prison construction, you must cut a bigger hunk from health care. He cited a May Public Policy Institute of California survey that found 8 of 10 voters were "very" or "somewhat" concerned about state health care cuts, but 61% said K-12 education should be spared compared with only 17% for health resources.

How do you do this job for a living, Cogdill was asked sympathetically. I think it's a mental health issue, he said with a weak smile. Yeah, mental health care is on the cutting board, too.