Demands of County Nurses Would Further Weaken the Whole Health System

The nurses’ strike against Los Angeles County has raised some difficult moral questions about health care in California.

Unfortunately, all of the questions seem to be concerned primarily with money, not patients. And when money and health care collide, the moral questions tend to get lost in the conflagration.

Throughout the 1980s California has been chipping away at health-care access for the poor. Now these cutbacks are affecting access for everyone.

Funding levels for even minimal programs have taken a decade-long nose dive. As services for the poor have repeatedly been trimmed, sliced and slashed, the private hospitals, which used to be able to take up the societal slack with “charity care,” are swiftly moving into the red. Many are being forced to close vital trauma and emergency services and to cancel their Medi-Cal contracts.

Politicians say that they have “cut out the fat” from our health-care system. In fact, what they have cut is more like muscle and bone.

The “system” by which we pay for health care--Medicare, Medi-Cal and private insurance plans--has become a four-foot blanket on a six-foot sleeper. It simply does not cover the basic necessities any longer. If you are pregnant and uninsured in Los Angeles County today, it takes four to five months to get your first prenatal appointment, and then the visit typically takes five to six hours of waiting for an examination that lasts five minutes. And fewer and fewer doctors are willing to see Medi-Cal patients, so most women in poor neighborhoods have no primary physician or obstetrician/gynecologist. Both of these factors combine to produce problem pregnancies, difficult deliveries and an infant mortality rate that is closer to Latin America’s than to North America’s.

Is this deplorable situation the fault of the county? In a word, no.

The county Department of Health Services, with its very limited base of resources largely controlled by the state, nevertheless is doing a tremendous job of battling an onslaught of social problems like homelessness, drug abuse, violent crime and poverty.

And then comes the nursing strike. Nurses at Los Angeles County facilities should and do receive appropriate pay for the critically important work that they perform. So do nurses in private hospitals. A nurse with two years of community college training and one year of experience is already paid more than almost any other occupation with similar training and experience.

But the whopping 19.5% pay increase that is demanded by the union would cost Los Angeles County $36 million. If extended to private hospitals, the figure would run to another $100 million a year. Since the state and federal governments have now capped most of the revenue that is used to pay for health care, those increases in salary costs would have to come from further reductions in services for everyone.

More trauma centers and emergency departments would have to be closed. Programs that serve the uninsured or the underinsured, mostly politically powerless poor women and children, would be pared down even further. If a society’s moral health is judged by the way it treats its disadvantaged, our state may be in need of a moral heart transplant.

What’s the answer?

It is not exorbitant wage demands that strain an already tenuous system. Obviously the answer is to reorder the priorities at the state level, where we have a billion-dollar surplus in the bank while babies are dying for lack of care.