Same Old Story for Public Health : Needy People Will Be Deprived of Clinics, Hospital Beds

Cuts of more than $29 million for public hospitals and clinics have been proposed to the Los Angeles County Board of Supervisors as a result of the governor’s June veto of more than $50 million in funds for county health programs statewide. Los Angeles County--projected to lose $20 million--will bear the brunt of the governor’s action, although more than 20 other counties also are considering reductions in indigent health-care programs.

The reductions would drastically reduce the care that is available at six county hospitals in Los Angeles--including Martin Luther King/Drew, County/USC and Harbor/UCLA medical centers. Half of the outpatient specialty clinics at Martin Luther King/Drew Medical Center would be closed. At Harbor/UCLA Medical Center the proposed clinic closures would deprive an estimated 1,900 patients each month of needed care. Many in-patient hospital beds would be closed at a time when the county’s public hospitals, unlike private facilities, are so overcrowded that some patients’ beds are moved into the corridors.

The Board of Supervisors will conduct the legally required public hearings on Wednesday to consider the proposed reductions. These hearings have been staged before, so all the actors know their roles. The supervisors will announce in fatalistic tones that they don’t want to make these harmful cuts but that they have no choice. Efforts are under way in Sacramento to restore the vetoed funds, and the board will use the hearing to press for increased state appropriations.

Advocates for low-income patients also know their roles. They will argue that the proposed cuts would deny necessary medical services to thousands of uninsured poor people, whose only source of care is county public hospitals and clinics. Physicians will testify that the reductions would harm patients, threaten medical-school training programs at UCLA, USC and Drew, and ultimately cost the county far more than would be saved in the short run. And they, too, will be right.

When the hearings are finished, the actors and the members of the audience will all be dissatisfied--even if the state comes through and no cuts are made this time around. No matter how tired we are of these roles, we will be forced to assume them again when the county faces yet another round of reductions.

The problem is a script that continues to ignore fundamental truths: 16% of all Americans are uninsured--an increase of 22% since 1979; most of the uninsured people are the working poor and their families, and 33% of them are children. A May, 1986, Field Institute survey of Californians found that 23% of those interviewed deferred seeing a doctor because of cost. Among families with incomes of less than $10,000 a year, 25% reported having no health insurance, and 42% said that they had not seen a doctor when they were sick. Recent UCLA studies show that such delays can lead to costly and severe illness, and even death.

It’s now time to rewrite this script--and the more authors the better. Certainly the state should try its hand. Other states have made dramatic efforts to increase access to care for the uninsured. In Florida, South Carolina and West Virginia all hospitals are taxed and the proceeds are used to finance low-income health programs and to reimburse hospitals providing the largest amounts of care to the poor. In four other states insurance companies share the costs of providing hospital care for the uninsured. In New Jersey this approach has ended patient-dumping--the transfer of uninsured poor from private to public hospitals--a common occurrence in Los Angeles. Several other states--such as Wisconsin, Washington and Massachusetts--are examining ways to provide insurance for the uninsured poor.

The business community also should help in rewriting this script. In Dallas, business has helped the city’s public hospital expand its pediatric-trauma program and create a poison-control center. A business group in San Francisco is working with that county’s public hospital to improve services.

The Los Angeles County Board of Supervisors should work on this rewrite, too, following the lead of places like Dallas and Kansas City, which run efficient and effective health care programs for low-income patients.

Finally, the people of Los Angeles must help. The county’s hospitals and clinics belong to us. We have paid for them, and we must not let these desperately needed facilities die a slow death. The poor--who live, attend school and work in our community--must receive at least a minimal level of health care for both economic and moral reasons.

Los Angeles is known throughout the world for writing scripts with happy endings. We are now crafting the true story of a public hospital system. This story should end not in tragedy but in a shared commitment to provide basic health care to those in need. Simple decency demands no less.

Geraldine Dallek is a health-policy analyst and Stan Dorn is a staff attorney at the National Health Law Program, a legal services support center in Los Angeles specializing in low-income health-care issues.