L.A. County: Ground Zero in Health Care

For the nearly 3 million hard-pressed residents of Los Angeles County who lack health insurance, it’s deja vu all over again.

Just when patients finally are returning to the county health care system, renewed fiscal problems are raising the specter of shortened service hours and longer waiting times--and yes, even potential closures and layoffs. With the county’s five-year Medicaid assistance package set to expire on June 30, the potential loss of some $230 million annually in federal aid could rip new holes in the county’s fraying health care safety net.

Anxiety--if not yet panic--is rapidly setting in among those utilizing and providing health care under the Medicaid waiver program. Patients are worrying whether they will still get appointments, and the county’s contract clinic partners are fearing for their continued ability to serve needy patients.

Meanwhile, sputtering waiver-renewal negotiations are threatening to spark a new round of recriminations in the recurring blame-game over our lack of adequate health care for the “medically indigent.” At a time of nearly unprecedented general prosperity, with unemployment at historic lows and Sacramento and Washington awash in surplus revenue, how is it that we are confronting yet another meltdown of the county’s health system?

Although it took place less than five years ago, it seems like only yesterday that President Clinton stood on the tarmac at Santa Monica Airport and announced the health-care equivalent of a Berlin airlift to provide embattled Angelenos with a life-saving package of resources and reforms to stave off disaster.

Thanks to the president’s vision and confidence in the county’s leadership, the Medicaid demonstration waiver granted by the U.S. Department of Health and Human Services temporarily redirected hundreds of millions of dollars in federal aid from hospital-based inpatient care to clinic-based outpatient care. Rather than trailing behind, the county thus was given a unique opportunity to lead a trend toward more widely available, community-based care that promised to treat patients earlier in their illnesses and at lower cost, and thus increase the region’s overall “wellness” while reducing its costly reliance on public hospitals as primary health care providers.

Did we squander our opportunity? No, but you’d hardly know it from much of the news coverage. Nearer the truth is to say that Los Angeles County is a victim of its own success. We pledged to reduce our hospital bed count by a third; we’ve reduced it by 30%. We promised to increase our outpatient visits by half; we’ve increased them by 20% over the pre-1995 health crisis level, and by more than 40% above the point when outpatient services hit bottom after the crisis struck.

In 1995, county patients had 45 outpatient clinics to visit; today, there are 170.

No question, the county has a ways to go. This is the best reason for continuing the waiver, not canceling it. That would be like taking down the traffic signals at a deadly intersection because they have failed to eliminate every accident. What we should do--what we must do--is maintain and build on the success we’ve achieved, and make it a national priority.

With broad-based, bipartisan support for investing in education, why is there no corresponding commitment to ensuring a healthy society? Unhealthy children can’t learn; unhealthy adults can’t work and produce. An unwell community consumes an inordinate amount of money treating costly illness, instead of sparing those scarce resources for more productive investments that can help communities flourish, not merely subsist.

I was very encouraged by Vice President Al Gore’s remarks during a recent campaign appearance, in which he supported the county’s Medicaid waiver extension, hailed the program’s success and suggested that under a Gore administration, such waiver projects should be easier to establish in other jurisdictions.

Unfortunately, we don’t have time to wait until a new president is sworn in next January; our current waiver expires in less than three weeks. Rather than viewing health care spending as a drag on the economy, we must begin to view it as an investment in future prosperity.

Nothing less than an all-out mobilization led by the federal and state government will do, and Los Angeles County is ground zero in this debate. Were some foreign power to invade our Pacific shores, the nation would not hesitate to rise to our defense. Yet today, roughly a fifth of our national population--and a third of our local population--stands in harm’s way from a lack of health coverage and the risk of ruin from untreated illness and crushing medical expenses.

Who will rise to their defense? Where is the political consensus to assert that inadequate health care is no less a threat to national security than hostile armies--and where is the political courage to confront this clear and present danger now, before it overwhelms us in the future?