COMMENTARIES ON HEALTH CARE : It’s a Valiant--if Modest--Attempt to Aid Medi-Cal Recipients : Its mission is to guide patients to providers of primary care, who will give or arrange necessary services, and pay for it.

“A modest step for Orange County health care; an infinitesimal step for humankind” describes the new managed care plan approved by the County Board of Supervisors on Tuesday.

OPTIMA (Orange Prevention Treatment and Intervention Medical Assistance) will be a quasi-governmental agency, headed by a supervisor-appointed commission. Its mission is to guide patients to a primary-care provider who will give or arrange necessary medical services and pay providers a fee per patient or a fee for service.

OPTIMA is not “a wholesale restructuring of the local health care system for the poor and disabled” as reported in the Times (Sept. 30). Nor should expectations be raised that it will solve access and comprehensive care needs of most local residents; problems first exposed in 1987 in a United Way Health Care Task Force report.

However, the supervisors have agreed to a valiant attempt to reorganize Medi-Cal involving about 250,000 “eligibles,” investing $4 million to $6 million in OPTIMA. The plan proposes to get patients to the right services faster, standardize costs, and give doctors and hospitals a greater return for the uncompensated care many have been giving over the last decade.

OPTIMA does not reach about 400,000 local residents who are “health care deprived,” more than half of whom are the working poor who crowd the dozen struggling community clinics. Thousands are turned away each week.

The indigent health care problem is worlds larger than Medi-Cal. OPTIMA gives only a faint future hope, several years down the road, to poor adults who must seek the last-chance public program, Medi-Cal services for indigents. That program has never served more than a third of the need in this county, being limited to capped state dollars by the severity of eligibility restrictions, a medical need “necessary to protect life.” The county supervisors do not allocate funds to it, establishing Orange County as the one of the lowest county supporters of health services in the State.

Supervisor Harriett M. Wieder, the Orange County Medical Assn. leadership and Hospital Council of Southern California have been exceptional in their efforts to create a program to remedy glitches in medical programs for the indigent. United Way’s Health Care Task Force, the coalition of 62 organizations working since 1987 with modest success in improving services, has supported the initiation of OPTIMA with some provisos.

But this modest step should be recognized for what it cannot do.

It will not bring most of the young families who are the working poor under health care protection, nor does it include the homeless, or lighten the costs for the taxpayer.

It will not alter significantly the cost-shifting that makes Orange County employers and employees pay a third more than the nation’s average for their health care. The middle-class and wealthy who have health insurance will still pay 20% more because providers will continue to shift costs when they have to care for financially strapped patients not on Medi-Cal.

It may provide a model for some reduction of paperwork that is a fourth of health care costs. It may have limited effect on provider fees, but will not generally impact origins of costs from excessive drug prices, the practice of protective medicine, misuse of technology or lack of planning in distribution of facilities.

Most significantly, it extends rather than modifies the regressive policy of the County Board of Supervisors to avoid county financing of primary care, a policy which has contributed to a 50% reduction in the Health Care Agency proportion of the county budget in the past 14 years.

Placing responsibility for development of OPTIMA on an arms-length commission, appointed by the supervisors, may take the county off the hook for its ultimate legal responsibility for the medically indigent under the Welfare and Institutions Code.

Orange County’s health care advocates need to participate in the planning, operation and monitoring of OPTIMA. But most of all, they need to get on with the many immediate tasks: the shoring-up of the trauma centers, getting the mentally ill off the streets and into rehabilitation, expanding the community clinics network, getting all children immunized, strengthening services in Latino and Asian communities, exposing the health care problems--and much, much more.