PERSPECTIVE ON HEALTH CARE : You Can’t ‘Right-Size’ Human Life
The appointment of Mark Finucane as director of the Los Angeles County Department of Health Services and the promise of $364 million in federal aid create the impression that Los Angeles is resolving the health care crisis that threatened closure of L.A. County-USC Medical Center and other county-run hospitals and clinics during the summer.
That impression of progress is illusory. The steps the county has taken so far are inadequate. The fundamental forces creating the crisis have not been addressed, and those forces, left unchecked, ultimately will bring down both our public and private health care systems, threatening the health, safety and economic future of Los Angeles.
Finucane is no doubt an able administrator, but installing him as director of the department will do nothing to reduce the crushing load on the county health care system. It was not designed to care for 2.7 million people. Having that many uninsured persons in Los Angeles depending on the county is why it takes more than $2.3 billion a year to run the system. We are not beginning to address that problem at a local, state or federal level.
Getting $364 million in federal aid plus another $50 million granted by the Metropolitan Transit Authority is laudable, but it doesn’t do the job when the health services shortfall, as of last October, was more than $800 million. That gap means that we must cut services, close clinics and wards and fire doctors and nurses, even though the people who need these services are still there, are still in need and will suffer unnecessarily and perhaps die as a result. To talk of “downsizing” or “right-sizing” an essential life-saving service based solely on budget criteria, not on public or human need, is cynical and foolhardy.
So what should we be doing? To give Finucane a fighting chance, we should first make certain that everyone in our community is able to get basic health services. We need to fund the county system at a level that will allow it to do a decent job for the 2.7 million people who currently have no other choice. Then we can begin to look at ways to reform the system to reduce costs and improve efficiency without killing anyone in the process.
We must dramatically reduce the number of people who depend on the county for health care. We know that roughly 80% of those people either are full-time employed or the dependents of full-time workers whose employers have chosen not to fund health insurance for their workers. We must prevent the business community from quietly shifting that responsibility onto the backs of taxpayers and employers who do provide coverage.
California should either mandate that employers provide health insurance or establish a government-based single-payer system or tax credits, cheaper benefit packages and other insurance reforms to extend coverage. In the end, we must either make sure that everyone has some form of coverage, as most other developed societies do, or announce that we are changing public policy and that people without some form of health coverage are on their own.
We should ask our state legislators why they acquiesced to Gov. Pete Wilson’s annual diversion, starting in 1992, of $2.6 billion--$900 million from Los Angeles County--of local property tax dollars to Sacramento to balance the state budget. That money alone would have kept our county system afloat while we reformed it.
The legislature--and particularly the Los Angeles County contingent--owes us an explanation. Were they outgunned in Sacramento? Did they not foresee the consequences of their action? Why have we heard nothing from them on the subject, when the health and safety of the citizens of Los Angeles is jeopardized? Do they have a plan to raise this issue with the governor and their fellow legislators? We have a lot at stake and we need to know.
We should ask the federal government to put block grants for Medicaid (in California, Medi-Cal) on hold. The proposed grants would impose a 20% cut in expenditures for Medi-Cal, when California already has the lowest payment rate for service providers of any state in the country. Given the tenuous state of health care in Los Angeles, we should not allow an added cut in funding until it is clear that no one will suffer or die as a result.
We can also ask why the federal government has not controlled illegal immigration, as required by law, and why it has not compensated communities like Los Angeles that bear a disproportionate share of the cost of taking care of illegal immigrants.
Los Angeles County won’t solve its health care crisis until it figures a way to provide basic health care services to all its people without relegating 2.7 million people to the county health care system. Continued failure is a direct threat to our health, safety and economic future.
