Rhetoric and the Real World

Campaign rhetoric doesn’t have much relevance to real life.

That’s a rule you can count on. I’ve seen it covering Democrats and Republicans, presidential candidates and novices running for the City Council. In every campaign, there’s the world of the political pulpit, and then there’s the real world.

This point, as important as it is obvious, was driven home recently during a press breakfast with Sen. Pete Wilson, the Republican candidate for governor.

As usual, Wilson wasn’t afraid to tackle a difficult issue. That’s the way he’s been since he arrived in Sacramento as an assemblyman a quarter of a century ago, an earnest, young Yalie who looked like the teacher’s pet. Today, after the years have added lines to his face, he remains the class grind, plugging away while others have fun.

The subject was the heavy cost of caring for poor pregnant women and their babies in urban public hospitals. Crack cocaine addiction, AIDS, diabetes, anemia and general neglect take a high toll on mothers and infants. For example, while the price of a normal three-day obstetric stay at County-USC Medical Center is $1,200, the cost of caring for a premature baby rises to between $1,800 to $2,000 a day.

Wilson proposed a solution. Increase money spent for prenatal care, for the public clinics that provide examinations, testing, counseling, instruction on good health habits and everything else that increases chances for a successful pregnancy. If that were to happen, it would be possible to reduce the large amounts of money spent on the expensive newborn, or neonatal, care.

Moreover, he’d spend money on rehabilitation of crack mothers. He blamed their babies for much of the premature birth problem. The proposal had a good, solid sound to it. A neat package. A perfect campaign speech.

And it defied reality. I found that out a few days later at the Neonatal Intensive Care Unit at County-USC Medical Center, where the sickest and smallest infants are treated.

On one point, Wilson’s right. Care of sick newborns is expensive. I saw a baby that weighed 1 3/4 pounds. He’d been born Sunday after 24 weeks in the womb with no prenatal care. Plastic wrap, the kind you use in the microwave, covered his body. Three tubes attached to him monitored his blood pressure, respiration, heartbeat and other body functions. A fourth was a substitute umbilical cord, nourishing him.

But Wilson has leaped from an accurate diagnosis of a problem to an improper course of care. Reining in the high cost of premature infant care is a more expensive and complicated proposition than Wilson, running as an economizer, lets on. Better prenatal care would reduce premature births, the doctors said, but a massive outreach program would be needed to bring in the women who otherwise go without it. Workers would have to fan throughout East and South Los Angeles, telling pregnant women to come to county clinics for prenatal care. Priests, teachers, parents would be needed in the effort. This would cost money.

Also, pregnant women now wait at least six weeks for their first appointment at county clinics. If outreach programs brought in more women for prenatal care, it would force a huge, high-cost increase in the number of clinics. Prenatal clinics would have to be open on Saturdays and at nights for working women. More money.

Also, crack’s more complicated than Wilson said. For one thing, the doctors told me, crack is responsible for a relatively small percentage of premature births.

Use actually is low among the women who have most of the babies at the state’s public hospitals, Latino women, many of whom come from a culture where the family religiously protects the woman and the unborn child. Nine out of 10 maternity patients at County-USC are Hispanic. In a recent, confidential survey, less than four in 100 of the patients indicated they used drugs. Yet, there’s a substantial number of premature births among them.

As for the addicted, Wilson’s goal of drug-free women will be hard to attain. “If somebody came and told me there are unlimited funds and unlimited resources, I wouldn’t know how to fix it,” said county Dr. Vera Stanincava, who treats crack mothers and babies.

I understand the reason for the oversimplification, even from someone as serious as Wilson. He and other political candidates are under pressure to produce instant fixes, easy solutions, something short enough for a commercial, a TV news sound bite or a one-liner in a televised debate.

But if Wilson gets into office, he’ll see how complicated the premature baby problem is. At best, he’ll propose something much different than his campaign speech. At worst, he’ll throw up his hands and forget it.

That’s why people are turned off by political campaigns. These election-year shows have lost their relevance to the voters.