Commentary : United Way’s Dire Health-Care Predictions for County Coming True

Orange County’s latest health care catastrophe, the “obstetrical diversion” policy of UCI Medical Center, fulfills the prophecy of the United Way’s “Orange County’s Health Care Crisis” report of two years ago: The current patchwork system is collapsing.

Under the obstretrical diversion policy, women in labor who have not been receiving prenatal treatment at the medicial center are turned away when both its obstetrics unit and emergency room are full. The medical center’s obstetrical overload is just a 3.5 magnitude precursor to forthcoming 8.7 level quakes in health services that will increasingly endanger the entire community.

The June, 1987, United Way report pointed to the consistent pattern of cost-shifting and escalation, service constrictions, reductions in financing and lack of communitywide planning. As a result, access to and quality of health care deteriorates daily, with virtually every resident affected regardless of income or position.

Unfortunately, most proposed actions are conditioned-reflex responses to the most immediate catastrophe, Band-Aids on the latest symptom, while the services--hospitals, emergency centers, home health agencies and health-care personnel--struggle for survival in a hemorrhaging system.

The United Way’s Health Care Task Force program has begun to pay off through increased citizen awareness and attention by public officials and media. Representatives of about 45 organizations--employer and labor groups, health providers, civic organizations--have been working to alert Orange County residents and civic and government leaders to the thousands of daily personal disasters created by the limitations on health care in this affluent county.

But it has become evident that little genuine progress can be made through the barrier of current stereotypical thinking about health care, or until changes occur in individual values and frames of reference of community leaders.

For example, the first reaction to the expanding need and diminished financing of health services has been to expect more effort and uncompensated work from health professionals, doctors, nurses and others. Outside the medical community, few realize that physicians alone give an estimated $220 million a year in uncompensated care in Orange County. Realistically, why should and how can the medical profession serve as the charity organization for a community that is unwilling to face up to the massive social problem of inadequate health services?

Another reflex proposal for a partial solution is the current legislation that would require health insurance coverage by small employers in imitation of employee benefits provided by larger companies. Certainly, the fact that nearly half the “health care uninsured” are young working families with earnings below or near the poverty level warrants special measures to strengthen our future generations. Such coverage is desirable and will help for a while. But it is a stopgap measure that will only temporarily meet some needs until it demonstrates the limits on health care that can be purchased for the available dollars in an uncontrolled market.

Stopgap measures only add to the paper-work blizzard that now accounts for 25% to 30% of health-care costs. Worse yet, they expand and continue a fragmented system of inefficient, costly and inadequate health-care benefits.

Adherence to the persistent belief that marketplace competition in health services will produce economy and efficiency is another example of rote mystical thinking. For example, that conception has produced hospital overbedding in Orange County, with only 40% to 60% bed occupancy, through the unplanned building of private, for-profit hospitals.

The advertising competition for higher-paying patients, passing indigent patients on to public and voluntary hospitals (known as “creaming”), the escalation of costs as a result of duplication of high-tech equipment and services, federal and state cost-shifting and other such practices have resulted in a logjam in public services. This is the message of UCI Medical Center, a state education institution that is carrying 60% of the indigent health care service in the county, in effect as the de facto county hospital.

There are many other values that require reassessment in light of today’s demographic and societal changes; for example, that massive health problems can be solved by local individual or private efforts. The fact is, about half of the money spent on health care, more than $400 billion, is government money.

The United Way Health Care Task Force has demonstrated that some small local gains can be made through public, voluntary and private cooperation. But it has also faced the stark reality that solutions are obtainable only through federal, state and county government collaboration and leadership.

We are also victims of the illusion that we always have the best health-care system.

Aside from having 40 million Americans without adequate health services, including more than 400,000 in Orange County, the United States has the highest expenditure (13% of GNP), and twice the administrative costs of the other industrialized nations, all but one of whom (South Africa) have national health programs providing basic health care to all their citizens.

It is extremely difficult to predict what alternative system will work best in the United States and Orange County.

But it is apparent that a modern, 21st-Century set of values must be substituted for the present behavioral conditioning that is guiding present approaches.

There are several principles subscribed to by most health professionals that provide guides to community action. Universality ensures equal access to health services, which should be considered a social utility in the same way that electricity and water are considered public utilities.

Comprehensiveness provides a range of services from prevention to terminal care to halt health problems at their earliest point.

Quality requires a maximum standard of care that encourages rapid recovery and prevents recurrences.

And equity spreads the costs.

Whatever the solutions to immediate crises or long-range fundamental service problems will be, experience has shown that they can only be achieved when Mr. and Mrs. Average Taxpayer and community leaders hear and see the facts, open their minds to alternative conceptions, and commit themselves to working with vested interests and diverse viewpoints to seek solutions in the best interests of the total community.