A Grim Prognosis for ERs

Los Angeles County is the economic engine of the nation’s most populous state, and like more and more parts of the country, it’s packed with people who are unhealthy and uninsured. As a result, even the county’s rich and fully covered are increasingly at risk of having no ER close or good enough to save them should they get in a wreck or suffer a heart attack. So why is the Bush administration weaseling away from the county’s request for an emergency infusion of cash for health care?

In the late ‘90s, Washington agreed to give the county about $246 million a year in supplemental health funding. But on Monday, President Bush’s Medicare and Medicaid director, Tom Scully, told The Times that additional cash would not be forthcoming. “We don’t want to create a meltdown of the L.A. County hospitals,” Scully said. But, he added, he doesn’t want to have to “explain to Houston and New York and St. Louis and Nashville why L.A. County is getting a special deal.”

“I don’t think it’s our responsibility to just write them a check and bail them out,” he said.

Scully’s reasoning cries out for a phrase-by-phrase response.

First, L.A.’s deal is not “special”--Scully has cut similar deals 1,950 times in the last two years. And they’re not bailouts. The deals give regions more cash than they would normally receive from Medicaid--the federal- and state-financed insurance for the poor--in exchange for a promise to serve patients more economically.

Also, Scully can remind those other cities that they are already getting plenty of help for their public health programs. Total Medicaid spending per enrollee in fiscal year 1998 was $3,101 in Texas, $7,180 in New York and $3,436 in Missouri. Nashville comes closest to having a legitimate gripe. Spending in Tennessee in 1998 was $2,583, the lowest of any state--except California, where it was $10 less. But Scully can point out to America’s country music capital that its population (a mere quarter the size of L.A.’s uninsured population alone) isn’t swelling because of Washington’s failure to control immigration at the border.

Finally, Scully should know that the people of Los Angeles are not asking him to “just write them a check.” L.A. County has already decided to close 11 health clinics and a trauma center in the Antelope Valley and may soon close two more of these subsidized, deal-with-any-problem emergency rooms.

Germs don’t quarantine themselves among the uninsured. And as any ambulance driver will attest, it doesn’t matter if the person on her gurney is rich or poor, Republican or Democrat, he is just as likely to die if there’s nowhere to take him.