A Health Crisis That Need Not Be : Blame Aplenty to Go Around, but All Can Rally to a Solution

Los Angeles County is in the middle of a public-health crisis. We are unable to care adequately for the growing number of AIDS patients in our midst; poor pregnant women cannot get the care that they need; syphilis, a disease that we had thought defeated only a few years ago, is spreading like wildfire, and the city’s trauma and emergency-room system is in shreds.

The blame for these conditions rests with both private and public sectors. First, the private hospitals in the county are acting irresponsibly. Our hospitals are some of the nation’s most expensive. While they close their trauma centers and emergency rooms for lack of funds, they have been on a buying spree--remodeling facilities, erecting multimillion-dollar medical buildings, purchasing the latest, most expensive equipment. This behavior might be viewed as rational if our hospitals were full and equipment was used to capacity. But this is not the case. While the county’s public hospitals are full to capacity and do not have enough equipment, private hospital beds are 40% empty and have equipment often standing idle. Private hospitals in Los Angeles County and statewide also provide much less care to the poor than do private hospitals in other counties and states.

The county Board of Supervisors must also shoulder some of the blame. The county snail’s pace in responding to the AIDS epidemic--its failure to forcefully lobby the governor and Legislature to get the health funding that the county needs, and its neglect of the county health-care system, our front-line defense against the spread of contagious disease--is inexcusable.

The governor and the Legislature also have been shortsighted. Gov. George Deukmejian, in what must be one of the greatest fiscal blunders in the state’s recent history, returned more than $1 billion to the taxpayers, only to see the state project a nearly $2-billion shortfall in tax revenues. How many Californians remember the amount of their rebate or what difference it made in their daily lives? How many would have preferred that the money go to keep our emergency rooms open, or provide AIDS education, or pay for syphilis surveillance or ensure prenatal care for poor women?

Nor is the general public blameless for the state’s and county’s public-health crisis. Although poll after poll shows that we support more health-care spending and are even willing to raise taxes to pay for it, we don’t seem to put our money where our mouths are. Is our commitment to public health only so much lip service? If not, why is this commitment not translated into public policy?

The questions are easy to identify. The answers are harder to find. At the county level, it’s time for the Board of Supervisors to realize that we have a public-health crisis that affects not just the poor but all of us. We need some straight talk about the problems and possible solutions. For the Board of Supervisors to wish the crisis away or throw up its hands over lack of funds, as it has too often done, is a striking failure of leadership.

In the wake of the news that the syphilis rate in the county is almost four times the national average, the board voted new funds for syphilis control. This is a little like closing the henhouse door after having invited the fox in; past county actions--cutting syphilis surveillance funds and charging a $20 fee for public-health visits--were bound to lead to a spread of the disease. Moreover, the board has not specified where the new allocation should come from. AIDS control? Prenatal-care efforts? Cutting public-health services is false economy. We need more money for public health. It’s the board’s responsibility to find it.

Private hospitals have to remember that they have a social responsibility that goes beyond serving only those who can pay. If they want to be treated like charitable institutions, they must act charitably. Emergency rooms are closing because hospitals and doctors are unwilling to care for emergency patients who can’t pay. A number of other states have addressed this problem effectively. For example, nine states have established hospital revenue “pools” to help pay the costs associated with caring for the uninsured. In these states, hospitals that don’t provide their fair share of indigent care are taxed to pay for hospitals that do.

Our state legislators, and especially the governor, must reassess their tax and spending priorities. If it takes increased taxes to meet the public-health needs of this state, then tax they must. If it takes the mandating of employers to provide a minimum level of health benefits to the working poor, as Massachusetts has done, then mandate they must. One current legislative proposal, known as “Baby-Cal,” would require employers to provide insurance coverage for prenatal care and preventive health care for workers’ children. Not a bad place to begin.

Finally, the people of this county and state must turn their attention from private to public concerns. We have government to provide us with “public goods”--the things that we value but cannot or would not individually pay for, like a clean environment, roads, education and public health. We make choices about public goods and what we spend on them at the ballot box.

This state is strong because of its people, and it needs to keep its people strong. How many more headlines will it take before we care enough to act?