It's the latest in the "blame, don't blame" game of health-care, finger-pointing -- with at least one worthwhile takeaway. The Public Policy Institute of California has a new report, "Emergency Department Care in California; Who Uses It and Why?"

Key findings: Fresno, Stanislaus and San Joaquin counties have the highest per-capita ED visit rates in the state. Most ED visits are avoidable. Don't blame the uninsured -- people with Medi-Cal or Medicare use the ED more often.  Don't blame undocumented patients -- they use less care and pay more out-of-pocket than native- or foreign-born patients.

The big "if's": The ED mess -- fewer EDs in the state, longer waits, more folks walking out in frustration without being seen -- would likely ease: IF there were more primary care docs (especially in the Valley); IF Medi-Cal paid better rates so more docs would treat Medi-Cal patients; and, IF docs would have evening or weekend hours.

I would also add things might improve IF the state's budget system got a transplant, IF hospitals that thrive by writing health-fair donations did more than nod at the needy and IF all the talk about improving quality by paying for better outcomes also applied to incentivizing pooling of medical resources for after-hours care and rural outreach.

But one slice of this Rubik's Cube that's in perfect alignment to me is the need for more docs. And the next click in the cube is going whole hog for a Valley medical school, the kind that UC Merced is pushing.  Community Medical Centers is a big public proponent of the effort. Heck, we help educate 200 medical residents and another 200 third/fourth year medical students every year, through UCSF.

It takes years to educate docs. It takes dollars and alluring opportunities to keep them in the Valley -- yeah, such things as a symphony, orchestra, baseball team, SaveMart Center and the region's only academic medical center at Community Regional.

But it also took years for the Valley to drill itself into this health-care hellhole (poverty, no insurance, lack of access, etc.) -- with help from countless blind eyes and shrugs at the state and federal levels.

So as the reports pile up redefining the word "crisis," we do have a new drillbit to dig our way out -- by speaking out, writing checks and having "Network" (remember the movie?) moments -- through advocating for a Valley medical school.

(For more information on the UC Merced medical school effort, visit http://med.ucmerced.edu/  And for details on the Public Policy Institute of California report, visit http://www.ppic.org/main/home.asp )