Health Care Not on Race’s Radar

The financial squeeze on health care in California, which threatens the viability of public hospitals, trauma care and emergency rooms, is largely being ignored in the state’s top political race.

But health experts and political scientists said the next governor is in for a rude awakening next year.

Among the grim realities in health care: Los Angeles County, faced with a massive budget deficit in its health department, may have to shutter two public hospitals to cut costs.

Other hospitals are closing ERs because of cost constraints, shifting the burden to neighboring hospitals that are already overworked.

The number of uninsured patients appears to be growing statewide as insurance premiums for the middle class are rising.

And faced with another multibillion-dollar budget shortfall, the state may be forced to radically curtail health services to the poor.

“It’s almost like an illness, you keep putting [treatment] off, and it’s only going to get worse,” said Lark Galloway-Gilliam, executive director of Community Health Councils Inc., which attempts to vocalize neighborhood health needs. “Nobody wants to talk about it because nobody has easy answers, and they’re only looking at short term. We’re really witnessing kind of a meltdown here.”

In his newest campaign commercials, Gov. Gray Davis boasts of providing public health insurance to 1 million children from low-income families during his four-year term, and of helping 45,000 consumers challenge their HMOs on everything from denied treatments to billing errors.

But when he describes what he hopes to address in his second term, he mentions schools, the environment, the economy and energy. Health care isn’t on the list.

Similarly, Republican challenger Bill Simon Jr. does not list health care, which comprises more than a third of the state’s total budget, among his top three priorities. His “Blueprint to Renew the California Dream” spotlights education, fiscal responsibility and the state’s infrastructure, such as transportation, water and energy.

“It makes the top five of every [election] poll I’ve ever seen of issues, and then the question is: Why doesn’t it make it into the debates or the TV ads, other than a one-line mention in some bland line of accomplishments?” said Bruce Cain, a professor of political science at UC Berkeley.

Cain attributed the apparent disconnect to the complexity of the issue and the powerlessness of the uninsured -- many of whom are poor and do not vote.

More Attention

“In health care ... there are so many people who can potentially be blamed for the breakdown of the system that you don’t assume it’s the governor,” Cain said. “You can always say the feds are responsible, or it’s up to insurance companies or private enterprise.”

Los Angeles County Supervisor Yvonne Brathwaite Burke, a Democrat, agreed that no one wants to be blamed. “I think everyone is just embarrassed by the whole thing and doesn’t want to talk about it,” she said.

Simon, who has served on the board of Childrens Hospital of Los Angeles, agreed that health care deserves more attention.

“You see the 11 clinics in Los Angeles that need to be shut down. You’ve got trauma centers in California that are insolvent. You’ve got doctors who are reluctant to accept Medi-Cal because of the reimbursement rates,” Simon said in an interview.

“This is not ... somebody howling at the moon. This is a bona-fide crisis that is swirling, and unless we start to do things to nip it in the bud, it’s only going to get worse.”

Simon has called for tax deductions for doctors who perform charity care and for allowing private businesses to purchase health insurance through the state’s Healthy Families program. That program for working poor families provides $2 in federal money for every $1 the state spends.

Still, La Prell Johnson, 62, said she is discouraged that health care hasn’t taken a higher profile in the campaign. Johnson’s health clinic was one of the 11 closed by Los Angeles County this fall in the first phase of cost-cutting. When she went to a different clinic earlier this month, she waited eight hours to see a doctor.

“People are so frustrated because of the long waits,” said Johnson, who has high blood pressure, arthritis, a pinched nerve in her back, a thyroid condition and kidney problems. “They’re ill. They’re in pain. It’s just so terrible. I think they [politicians] know about it, but I think they mostly ignore it.”

Asked in an interview why he didn’t spend more time discussing the looming problems in health care, Davis said he preferred mentioning his accomplishments. “I like to speak to something that immediately resonates with folks,” he said.

Until this month, Davis had rebuffed requests from Los Angeles County supervisors for a meeting on health issues. As the supervisors, faced with a health-care deficit of $500 million to $750 million in three years, steamed toward a vote on closing hospitals, they became increasingly critical of what they saw as the governor’s inattentiveness.

The sharpest critics were fellow Democrats: Gloria Molina and Zev Yaroslavsky.

“If he is going to be the governor for the next four years, he has to be responsible to all of us on this matter,” Molina said last month.

It was after that sort of remarks that Davis agreed to meet with Molina and board Chairman Yaroslavsky. Afterward, he said he was open to calling a special session of the Legislature on health care in January, as the supervisors requested.

Since the meeting, the Democratic supervisors have reined in their critiques of the governor. “The governor has made a commitment to not leave us standing alone,” said Molina’s spokesman, Miguel Santana.

Davis said his staff has worked with the county for several months to seek additional funding from Washington that could head off hospital closures.

“I get blamed for athlete’s foot and for the drought,” he said.

“I certainly don’t want to put anyone down that blames me,” he said. “I think they would agree that we’re now on a constructive path and all pulling in the same direction.”

Because the state budget protects other programs -- including education -- from year-to-year budget swings, some experts said it is inevitable that health care will be among the first programs to be cut if, as predicted, the state faces a large deficit next year.

Both Simon and Davis said they want to see the specifics of next year’s budget deficit before saying whether health cuts are needed.

“Rather than automatically say we’ve got to limit the scope of coverage, why don’t we take a look at whether there’s existing waste and mismanagement in the system?” Simon said. “There’s so much money sloshing around in the system.”

Linda Rosenstock, dean of the UCLA School of Public Health, said cuts to health care are coming “unless the economy does something rather impressive in this year coming up, which does not look likely.... I don’t see any way it’s not vulnerable if we’re not willing to increase revenues.”

‘Budget Crisis’

Simon has knocked Davis because California was forced to relinquish its claim to about $740 million in federal funding for children’s health insurance because California didn’t spend the money -- which required matching dollars from the state -- within a three-year time limit.

“Talk about a budget crisis,” he said. “My golly, our state government left on the table in Washington over $700 million, and it’s a shame.”

Davis said his administration increased the number of children in the Healthy Families program from 50,000 at the beginning of his term to more than 600,000. He has lobbied Congress to give the state more time to spend the money.

About 6.2 million people in California, or 21% of the non-elderly population, lacked health insurance at some point in 2001, a UCLA study shows. Though the number of uninsured has declined in recent years, experts say the current economic downturn may have erased those improvements.

Separately, studies have shown that health insurance premiums will increase 12% to 15% next year, nearly the same rate of inflation that spurred the growth of managed care in the early 1990s.

Meanwhile, Joan Moxley-Brown, 62, who lives in Lakeview Terrace is left to worry about where her medical care will come from.

Moxley-Brown, a retired systems analyst for medical facilities who lacks private insurance, has high blood pressure, diabetes and renal failure.

Her local community clinic, Tujunga Health Center, closed and her most convenient alternative, Olive View-UCLA Medical Center, is on the chopping block too.

“It’s obvious that the things that are important to the citizens of this country are not as important to the people who are in charge,” Moxley-Brown commented.