OVER THE YEARS, we've gotten used to the Pennsylvania Legislature trying to balance the state budget on the backs of the most vulnerable. But this time, Republicans in control of the state Senate are legislating as if no one in their districts gets sick.

That's the conclusion to be drawn from the severe cuts to health-care services included in its budget proposal: Not only does it slash medical help to people who are struggling financially, it would kill innovative programs that result in improved health for everyone who visits a doctor.

Instead of taxing smokeless tobacco - Pennsylvania is the only state that doesn't - the Senate would rather prevent the families of 12,000 children from buying health insurance through the Children's Health Insurance Program. Instead of taking cash from the rainy-day fund - and if the worst economic crisis since the Great Depression isn't the "rainy day" envisioned by the Legislature, what is? - the Senate would rather deny community care that would keep 2,000 older people from having to go into nursing homes. To make matters worse, many of the cuts would deprive the state of federal matching funds.

The Senate's budget also would zero out the Governor's Office of Health Care Reform and, with it, two innovative programs with the potential to help transform the way health care is delivered to everyone, rich or struggling - health care focused on prevention, which costs less in both money and suffering.

Much of Gov. Rendell's sweeping health-care proposal, Prescription for Pennsylvania, was blocked by this very same state Senate, but a "chronic-care initiative" was tried out in this region a year ago and is now being expanded throughout the commonwealth.

The program has leveraged $1.5 million in state funds to bring in $28 million from 16 health-insurance companies to redesign the way primary-care doctors and nurses work with patients. Instead of following the typical model in which as many patients are seen for as little time as possible, the initiative provides training and financial incentives to use a team-based approach that is oriented to individual patients - for example, planning their visits in advance and also allowing patients to get same-day appointments when problems come up.

The initiative is directed at patients with chronic illnesses such as diabetes or childhood asthma, but the advantages are shared by everyone. In Pennsylvania in 2007, $4 billion was spent on hospitalizations that could have been prevented at the primary-care level. That's a lot of wasted money and unnecessary pain.

So far, the chronic-care initiative has produced measurable improvements in the health of patients. It has been hailed as a national model of how we want to repair our broken health-care system. But if the Office of Health Care Reform is killed, the initiative also dies: Antitrust laws prevent private health insurers from coordinating the reimbursements they make.

In addition, Pennsylvania's share of $19 billion in federal stimulus funds to establish electronic medical records also is at risk. The same office is in charge of developing the Pennsylvania Health Information Exchange, the technology "highway" that must be in place to qualify for the funding. If the Office of Health Care Reform isn't around to establish PHIX, millions and millions in funding for the records could be lost - not to mention the improved safety and reduced costs.

On nearly all fronts, but especially health care, the Senate's cuts would end up costing more than they save. Our diagnosis: The Pennsylvania Senate is engaging in severe self-destructive behavior.

It's time for constituents to do an intervention. *