This summer, the national health care reform debate in California became real for many when Gov. Schwarzenegger enacted the worst funding cuts to HIV/AIDS care and services in a decade. He also delivered unbelievably deep cuts to child health, domestic violence victims, foster care children, mental health programs and other public health safety net programs.

As the specific details of what these funding cuts will mean to Californians become more evident, the phrases I hear most from public health analysts are, “Stunningly stupid … and fiscally irresponsible. These cuts will cost billions in other health and business costs to California taxpayers.”

These services are often called “safety net” services. That phrase has two meanings. It refers to the safety net provided for those whose illnesses cause them to “fall through the cracks” of the health insurance and care systems. But it also refers to the safety net provided to protect California taxpayers from the costs incurred by not providing care at a manageable level, which forces overall costs up as the level of care required increases.

For example, the governor of California has chosen to cut programs like HIV viral load testing. Viral load tests tell physicians whether or not HIV medications are working properly to reduce levels of the virus. This is vital because the level of the virus in the patient is related to the likelihood of transmission and the development of opportunistic infections and related complications. Eliminating this testing increases the chances that the patient will transmit the disease to another person or develop much more costly complications – both of which end up costing the taxpayer millions more.

These are short-term savings guaranteed to bloom into long-term fiscal disasters for California’s taxpayers.

As the fiscal impact of all of these cuts becomes clearer, and as the health care debate grows more and more vitriolic, I can’t help but focus on the people who will bear the greatest burden. Real people, in real pain, terrified about their future and the future of their families and all those impacted by HIV/AIDS. People who can’t get health insurance, people who can no longer work, people who need access to health care to continue to live.

Every year the San Diego HIV Planning Council struggles – often with rage and sometimes with tears – to balance a budget they know is inadequate to serve the needs of those impacted by HIV/AIDS and to help prevent the spread and increasing cost of the disease.

This year, the rage and tears flowed even more abundantly in the face of a budget that was nothing more than a devil’s bargain. Because of the governor’s cuts, the Planning Council must find dollars to cover the viral load test somewhere else. To meet this need, and many more, funds must be eliminated from programs that help people living with HIV/AIDS obtain food, housing, bus passes and assisted transportation programs that help them get to their health-related appointments. There is simply nowhere else to pull those dollars from.

The result is devastating – we can get viral load testing as long as patients can live with less food and fewer chances at housing, and can wait hours after chemotherapy-like treatments until they are physically stable enough to use a bus.

These funding cuts will increase disease and death rates. They will increase the risks to the general public. They will increase the costs of health care to the taxpayer. It’s an unbelievable and devastating trifecta.

Every elected official – our U.S. senators, Gov. Schwarzenegger, the California state assembly members, the California state senators, every member of the San Diego Board of Supervisors – should find their call sheets and their e-mail boxes full of the stories of lives dismantled because of disease, the costs of health care and the even larger costs of having no access to health care. Phone lines should be bursting with health care advocates asking for appointments with elected officials and telling them about the “on the ground” impact of the governor’s actions, painting the real life picture of the people who are paying the human cost for this travesty that passes for public health policy.

Make those calls, write those e-mails and letters. Use your voice to help today. Real people – people you know, care about and love – are counting on you.