PERSPECTIVE ON HEALTH CARE : We’ll All Feel Cuts in County Services : A state grab of county funds could mean that none of us will have access to emergency care, for trauma or illness.
Gov. Wilson proposes to take $2.6 billion of county property taxes to help solve the state budget deficit. Public discussion has focused on the effects of this tax grab on police and fire protection, courts and jails. At the very end of their lists of havoc, a few policy-makers have included county hospitals and health services.
It’s almost as if our politicians, facing very tough choices, were saying, “For God’s sake, leave the middle class (read voting public) alone and visit your devastation on the poor (read non-voting).” Quite apart from the cynical implications of that dialogue, there is a major misreading of the substantial effects on access to health care for all of the public, not just the poor. Let’s look at the possible impact that such a statewide shift of county property taxes would have on all of us, whether we are likely to vote or not.
In response to the anticipated property-tax loss, the Los Angeles County Board of Supervisors is considering a slash in support of the Department of Health Services of more than $190 million, from a current level of funding for the department of about $2.2 billion. That doesn’t sound like much--a mere 9% reduction. But on closer examination, we see that the $190 million comes out of the property-tax contribution to the operation of the department, an allocation which this year totals $398 million. The proposed cut would represent a nearly 50% reduction in county funding of health services; its total effect would be magnified by reducing the ability of the department to earn major revenues for patient care from state and federal sources.
Ten years ago, when the trauma system was put into operation, there were 21 trauma centers--three operated by the county and 18 by private hospitals. Today, there are only 13 because the insurmountable burden of an uninsured patient rate of 60% has forced eight of the private-hospital-operated trauma centers out of business. The three county-operated trauma centers in Los Angeles receive about half of all county trauma cases (public and private together). More than 60% of those trauma cases involve uninsured people. The closure of even one of those trauma centers will have an unprecedented domino effect, the likes of which the public can hardly imagine, on our already deeply troubled trauma system.
The remaining private trauma centers manage to survive with modest public supplements from the tobacco tax, but those supplements are also threatened in this terrible budget year. And here is where real tragedy begins. The closure of any county trauma services means that there will be a sudden shift of uncompensated trauma care to the private services. That will quickly drive the remaining private operations to close their doors. The resources simply no longer exist in the private sector to carry that burden.
But the problem doesn’t end there. A major component of any reduction in county-operated emergency services will be a similar domino effect on the remaining non-trauma private-hospital emergency services. Ten years ago in Los Angeles County, 103 private hospitals provided emergency-room services, apart from the trauma system. Today, that number is 85. The closure of 18 private emergency rooms in the past 10 years can be traced to the same cause as the closure of trauma centers--an overwhelming burden of uncompensated care. That burden comes from the 2.7 million uninsured people in the county, 87% of whom are either employed or are the dependents of employed persons. If you are uninsured, whether employed or not, the local emergency room is the only place you can be sure of being cared for when illness strikes.
So we are not addressing just a problem for those in poverty or for undocumented immigrants. All of us will be affected, with the strong probability that none of us will have access to emergency care, whether necessitated by trauma or by sudden illness.
Few are aware that we all, rich or poor, share a deep dependency on an intact county health-services system. It is a dependency that extends far beyond the dramatic example of trauma and emergency services, and includes both the growing threats inherent in under-immunized populations and control of the growing epidemics of tuberculosis, AIDS and hepatitis. These threaten us all.
It is not too late for the policy-makers to reassess priorities. None of us, whether affluent, native born, employed or not, can escape the serious and unacceptable consequences of the loss of major county health-service capabilities.
