The California Healthline gives us a disturbing wrap up of how the state's fiscal crisis is going to affect how Californians access health care. Especially vulnerable groups include low-income children, kidney patients on dialysis and people with HIV/AIDS.

California's fiscal problems go back decades, in part to the state's tax revolt of the 1970s, and health care costs are by no means the state's only economic problem. But they are part of the problem—and a reminder that 1) states can't fix health care costs alone; we need a comprehensive national approach and 2) we have to be realistic— if we want services, we have to find a way of paying for them. And that often means taxes. Even in California, where a minority of lawmakers can easily block taxes and tie the state up in budgetary knots.

Gov. Arnold Schwarzenegger did of  course try, and try  hard, to reform health care in the state in 2007. Now he has proposed cutbacks that even some Republicans have called drastic.

Among the proposals:

• Cut state spending by $247.8 million by eliminating Health Families. That would also  result in a loss of about $500 million in federal matching funds

• Eliminating Medi-Cal coverage of dialysis, and some limits to breast and cervical cancer services 

• Cut $55.5 million from state spending on the AIDS Drug Assistance Program and other AIDS initiatives. 

Some Democrats urged higher taxes instead of such deep cuts. People get sick no matter what the budget looks like, and the costs won't go away, they'll just get shifted, maybe to someplace more expensive like emergency rooms. But Republican State Assembly member Roger Niello told the Sacremento Bee, "I think everybody here would agree, Republicans and Democrats alike, that we would not want to make these drastic reductions that we're going to be making if we didn't have to."  He added, "But the unfortunate fact is, we have to."

He's right that they are unfortunatee, but he's wrong that they are inevitable. No state "has" to cut basic health services for vulnerable people. Not even California. We don't know how the state will resolve its latest budget mess, but we hope this is some kind of bargaining chip, not a vision of the future.