California’s Medical Crisis

The decision to close the trauma unit at Hollywood Presbyterian Hospital and indications that additional doctors will now withdraw from serving Medi-Cal patients are dramatic signs of a crisis in health care in California.

Hollywood Presbyterian officials are being forced into the decision to close the trauma unit by the continued failure of the state to pay the costs of care for indigent patients and by recent indications in Sacramento of further cuts in the already underfunded programs. The doctors are faced with similar problems in Medi-Cal, which pays them scarcely 40% of their normal fees and would pay even less under further cuts proposed by Gov. George Deukmejian.

The governor appears to have hastily applied the budget ax to health care on bad advice from his staff. Some of the basic arguments put forth by his principal assistants for the drastic action have now been exposed as erroneous by a careful study by the legislative analyst. There is a good chance that the governor, armed with this new information, will have second thoughts and move to improve the public health programs, not cripple them.

Two singular facts emerge from the work of the legislative analyst:

--Medi-Cal services in California are not, as the governor’s staff has implied, gilt-edged. The cost per eligible person for all services falls substantially below the national average for Medicaid services, and is the lowest among the 10 largest states.

--Expenditures for Medi-Cal services to low-income families, and services to the medically indigent--those with no insurance whatsoever--fall far below the appropriations limits set by the Gann amendment to the Constitution. The Gann amendment is a mischievous, defective, counter-productive measure, but it can in no way be used to justify health-care cuts.

These findings confirm that more money, not less, is essential to meet minimum needs for public health, and that is without taking into account the increased costs that will certainly develop around the rising AIDS caseload. The findings also confirm that the state can afford to spend more.

The needs, and the desperate problems in meeting those needs, were effectively demonstrated in hearings last week before the Joint Legislative Task Force on Medi-Cal. After hours of testimony from beleaguered health-care providers, including hospital administrators and doctors, Assemblyman Bruce Bronzan (D-Fresno), co-chairman of the task force, concluded that “the system is on the verge of collapse.” Los Angeles County has been particularly hard hit by consistent underfunding of medically indigent service programs. The proposed cuts in Medi-Cal would further increase the burden for indigent services. This year alone, because of the governor’s decision to withhold $25 million from the indigent-care program, Los Angeles County has already been forced to order the closing of some beds and outpatient clinics despite rising caseloads. County hospitals’ obstetrical services, now at saturation levels, are having to contract with private hospitals to help meet a 14% increase this year alone in births. Robert Gates, county director of health services, told the task force that “we have accepted our role as the safety net” but, “in fact, the safety net is strained to its maximum.”

Deukmejian has shown imagination in reviving the flagging funding of the University of California. That stands as a singular achievement of his first term. There now appears to be a remarkable opportunity for him, in his second term, to bring imagination and leadership to two other conspicuous problems: the repair of the rest of the education system, and the restoration of the state’s public health system.

In the case of both endeavors, the short-term costs translate into significant long-term savings. Strengthened elementary and secondary schools and community colleges are essential to the economic vigor of the state. The effectiveness of adequate public health services for low-income and disadvantaged people are quickly translated into enormous savings in the desperately high cost of postponed treatments.