Make no mistake, it is a broken system. Hospitals and physicians have been living with the effects of this crisis for some time now demonstrated by hospital closures and relocation of providers. For example, in the past decade, more than 65 emergency rooms and more than 70 acute-care hospitals have closed statewide. San Diego County has lost seven hospitals since 1996.

The hidden tax the governor refers to as a result of cost- shifting is real as are the effects of consistent and growing unfunded mandates. As the governor accurately indicates in his plan, care for the uninsured and underinsured comes at a price to all of us. When medical bills go unpaid, hospitals must shift the costs onto those who can -- those with health insurance. This hidden tax - - in the form of higher-priced premiums, deductibles and co-pays -- costs each insured Californian $455 a year, according to a study released in December by the New America Foundation.

Certainly, hospitals and physicians are not enthusiastic about all elements of the proposal. We recognize there is a crisis, and we are more than willing to be a leader in finding solutions. Rather than draw a line in the sand, we recognize that the negotiations ahead will be tough. We expect a lively debate. The debate is welcome after decades of piecemeal legislation, false starts and silence on this issue.