Life on the edge

Some dangerous assumptions are being made in Sacramento these days.

When Gov. Arnold Schwarzenegger delivered his revised 2009 budget to the Legislature in May, in it were more than $1.5 billion in cuts to health and welfare services, including programs such as Medi-Cal and primary care for the uninsured.

Clearly, one assumption the governor made was that, even though these cuts would add hundreds of thousands to the ranks of the uninsured and create even more financial hardship for hospitals and health centers teetering on the brink of closure, the healthcare system can handle the added stress.

It cannot -- at least not in Los Angeles.

Perhaps things are better elsewhere in the state, but already here one-third of visits to emergency rooms are made by the uninsured. And largely as a result of the financial strain caused by those unreimbursed visits, 15 general acute-care hospitals in the county have closed since 2000. In some neighborhoods -- such as South Los Angeles, where six hospitals have shuttered their emergency rooms since 2003 -- there is less than one hospital bed per 1,000 residents, compared with a national average of more than four. At this rate, it may be only a matter of months before the entire local healthcare system becomes totally destabilized, resulting in long delays in treatment and avoidable deaths.

But what if Los Angeles, in this shaky state, were to be hit by a natural disaster, an influenza epidemic or a terrorist attack?

Clearly, those who would cut funding for healthcare also assume that none of those things will happen here. Yet we all know that Los Angeles is prone to earthquakes and fires and vulnerable to tsunamis. It is also an international crossroads, accommodating travelers from every corner of the globe every day. And let’s not forget it is the second-largest metropolitan area in the United States and was on Al Qaeda’s hit list in 2002.

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It’s time for all of us in L.A. County to reject the easy assumption that “everything will be OK; it always is,” and face the jarring reality that we are living on the edge. Not close to the edge, on it. Los Angeles is becoming the Lower 9th Ward of California -- dangerously exposed to any shocks to the healthcare system and with few sympathizers in government outside our immediate geographic area.

Fortunately, in mid-July the Legislature’s budget conference committee approved a new budget that would undo the governor’s $1.5 billion in cuts. It remains to be seen, however, whether the committee’s budget can get the two-thirds majority it needs to pass the Legislature. It relies on a $9.7-billion tax increase, which numerous legislators -- including budget committee members from Sacramento and Riverside counties -- have vowed to reject.

Of course, none of them live in Los Angeles County.

And so this budget battle is not just about the fate of a few hospitals or clinics; it is about the long-term viability of Los Angeles County and the well-being of everyone -- insured and uninsured -- who lives here.

A homeless man living under the Santa Monica Pier recently told a Venice Family Clinic physician doing street outreach that after Hurricane Katrina, he fled New Orleans, heading due west on Interstate 10.

“This is as far as it goes,” he explained, implying that if he could have gotten any farther from New Orleans, he would have.

Naturally, this makes one wonder where we would all go if Los Angeles were to suffer a similar calamity, because its healthcare system certainly isn’t equipped to handle such an emergency.

Perhaps Sacramento and Riverside have room for us.