Working in the emergency department does not teach anything about tax policy, but it does teach you that bad stuff flows downhill. From the ED the proposed Maine property tax cap referendum on the November ballot looks like a big pile of trouble headed at those who live on the downhill side of Maine.

The proposal to cap property taxes at 1 percent of assessed value will whack $600 million-plus out of the budgets of Maine’s cities and towns. Much of that $600 million is certain to come out of the social safety nets that protect Maine’s poor from life’s gravity, and the public safety nets we all will need some day to keep us from hitting life’s pavement.

Proponents of the 1 percent cap on property taxes claim the cap will force fiscal conservatism and less waste of taxpayer dollars. They point out Maine’s high tax burden and the threat of high property taxes to property ownership. They believe lawmakers will never spend wisely if they do not have less to spend a lot less.

Maybe they are right. But the tax cap will get rid of government waste the way amputating a leg gets rid of a foot callus. It will wreak havoc on the streets, among the poor, among the mentally ill, in the parts of Maine hidden in the social shadows, and in those agonizing moments when one of us is in trouble and desperately waiting for help.

The reason for that is no state of Maine’s size can absorb $600 million in tax cuts without social services, emergency services and schools taking it right on the budgetary kisser, because those services are where cities and towns have discretionary spending. Those are the same services that stand between the poor and the desolation of abject poverty, the emergency services that stand between some of us and the grim reaper, and the schools that bridge the gap between rural poverty and opportunity.

No one should vote for the so-called Palesky tax cap (named after its principal proponent, Carol Palesky) without knowing what it will look like in Maine’s emergency departments when $600 million is cut out of the municipal heart of Maine. No one should support it without being able to stare into the faces that will bear a disproportionate share of its pain. Here’s a glimpse of those I believe the future will bring to the ED after the tax cap poleax of Palesky hits Maine’s cities and towns:

. Too many patients who waited too long for ambulances and paramedics because many towns will be forced to cut emergency medical services. More of us will learn what it feels like to wait too long for an ambulance when we are in desperate trouble, longer with the emphysema patient gasping for air, longer with the trauma patient whose life hangs by a thread that can be snipped by a delay in care, longer with the chest-pain patient wondering if it is his heart in trouble.

. Too many homeless patients with nowhere to go, because this state can have $600 million in tax cuts or it can have shelters for the homeless but I doubt it has a prayer of affording both. In the ED that means more homeless patients, some with feet rotting in wet shoes because they have nowhere dry to go, and all with ED discharge instructions full of good intentions ruined by the reality that the patient is being discharged to the street. Some of those homeless patients will be teenagers way too young to fall that hard because the richest society in the world cannot afford a social safety net.

. Too many mentally ill with little real help when the mind becomes a kaleidoscopic carnival ride of fear and chaotic thinking, and suicide seems like the only clear path out of the mental darkness.

. Too many teenagers in trouble because there is no social backup to their troubled homes. They will fall through the cracks left by too few guidance counselors in the schools, and too many teachers in classrooms too large for them to notice when a troubled student is walking with one foot over the edge of big trouble. There will be too few school nurses for troubled teenagers to talk to teach about sex, and to reach adolescent girls about to grow up too fast.

. Too few public health nurses, the kind out there on the social front lines checking in on new moms to make sure they are not falling apart under the twin pressures of poverty and parenthood. Those nurses are often the first of us to find children in homes of abuse and neglect.

Tax cap supporters, of course, argue that this is all just scare tactic, that these kinds of things will not happen. They are deluding themselves, because these kinds of things are already happening and the property tax cap will make them happen much more frequently.

There is little doubt Maine has a tax burden too high for many of its citizens. The property tax cap initiative grew in part out of frustration with our collective failure to address the issue of high property tax burdens for some. The problem, however, requires a state legislature’s scalpel, not a tax cap referendum’s chainsaw. The one percent tax cap proposal which may save many of us property tax dollars will be paid for by others having the worst nights of their lives in the ED.

When we consider our vote on the tax cap proposal we should all remember this: Some day life will find a way to leave each of us looking at the fast-approaching pavement and hoping for the safety net, or living on the downhill side of life’s pile of trouble coming at us. That is when we will all be thankful the property tax cap got voted down this November.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.