The Poor at Risk

The Legal Aid Foundation of Los Angeles has sponsored a survey of the troubling condition of medical services for the poor in Los Angeles County that demonstrates the cost in human pain, suffering and even death when there is inadequate funding. The study deserves urgent reading in Sacramento, where political stubbornness over the state budget--the key to remedying these problems--risks further deterioration of county services.

What the researchers found in Los Angeles County is true in Orange and San Diego and Ventura counties as well, for no county in the state is free of the problems created by inadequate funding for public-health services. The story is essentially an account of highly competent professionals trying to serve a population that is expanding at a rate far faster than the resources made available for its health care. As a result, emergency surgery is postponed for weeks if not months, prenatal care is sometimes delayed until the advanced stages of pregnancy--if it is available at all--and emergency rooms are described by the physicians themselves as “battle zones” as more and more people, without regular health care, are forced into trauma centers in desperation as neglected health needs reach a crisis stage.

And the most troubling fact of all is that this problem, forced by the denial of adequate funding, actually is increasing the costs of public health in the long run as illnesses and abnormalities that could be addressed quickly and relatively cheaply in their early stages are left uncared for until they are complex and costly.

The County Supervisors, under the rigid restraints of Proposition 13, have little flexibility. They have managed to increase the spendingfor health and sanitation from $708 million to $1.5 billion in 10 years--an increase of almost 10% in constant dollars. During the same period, however, county hospital admissions have increased 40%. Furthermore, for next year the county has proposed a $22-million increase in its AIDS program, including $5 million in new county funding plus federal, state and special fees--an increase that is sorely needed but that further drains funds available for general health programs.

The sum of the fiscal problem is simply that the county, even if it gets all the new funding proposed in the state budget passed by the Legislature, will only be able to stand still, with little or nothing left over to alleviate the problems identified in the Legal Aid Foundation study. And now, with Gov. George Deukmejian’s veto of supplementary funds for 1986-87 indigent-care costs and his insistence on a massive taxpayer rebate, there is the prospect that he will make massive cuts in the 1987-88 budget for indigent care, Medi-Cal and trauma-center funding, forcing the county to make grave cutbacks--with a further deterioration of services. Indeed, many of the governor’s cuts are expected to have a double effect because both state funds and matching federal funds will be lost.

“The system is under siege,” Geraldine Dallek and E. Richard Brown, the public-health specialists who made the study of Los Angeles County health services, concluded.

The blame must be widely shared. The critical ingredient, the underfunding, is a direct result of the taxpayers’ revolt that saw passage of both Proposition 13, restraining local taxation based on real estate, and Proposition 4, the Gann amendment to the state Constitution that created arbitrary limits on state spending that now threaten to cripple essential services. Until those measures are reformed, there can be no solution.

For many taxpayers and voters, the savings inherent in those initiatives are welcome. And the pathetic results, at least in terms of health services to the poor, are largely invisible. There is no room for complacency, however. There are consequences for the entire population. This is already dramatized by the closing of trauma centers by hospitals overwhelmed by uncompensated care.

Substandard health care is an injustice that is inconsistent with the American commitment to fair and equitable services. Beyond the cruel injustice there are enormous economic costs in the denial of appropriate health care, and there are risks to the health of everyone as the diseases and disabilities of the poor are neglected.