The Next L.A. / Reinventing Our Future : Health Care : Imagine if we could build a better health-care system. It’ closer than you think.

UCLA Medical Center. Cedars-Sinai Hospital. Long Beach Memorial. White Memorial. St. Johns. St. Vincent. Childrens Hospital. Kaiser. Torrance Memorial. Valley Presbyterian. Century City Hospital. Motion Picture and Television Hospital. Glendale Adventist Medical Center. Santa Teresita Hospital. Mission Hospital. Hospital of the Good Samaritan. . . .

Too many hospitals--148 in Los Angeles County alone. Too many hospital beds--31,300 in the county, more than half of them unoccupied at any given time. Too much expensive high-tech equipment clustered in one area and not enough in another. Trauma centers in the wrong places.

There is a lot about about Southern California’s health-care system that makes no sense.

It grew up, as nearly every regional health care network in the nation did, in parochial fashion--a little community hospital here, a religious medical center there, a teaching hospital to help train the local university’s medical students. Each with its own sense of mission and not much interest in working cooperatively with the hospital around the corner.

But in this era of concern about rising health-care costs--when the trend is toward keeping people out of the hospital instead of letting them in--these facilities are competing for a shrinking pool of patients.

For years, the best minds in health-care policy have tried to come up with ways to make the system more efficient, to scale back the number of hospital beds. They call this “rationalizing,” a policy wonk word for getting the system to make sense. But hospitals are, after all, businesses, and who in business wants to downsize or close up shop?

Now an earthquake--which damaged several area hospitals, knocking 2,500 beds out of commission in the Los Angeles Basin--has done what the experts could not. “The 30 seconds of the earthquake,” said UCLA surgeon Michael Zinner, “potentially did more to rationalize health care than years of health-care planning.”

So the experts and the analysts and the pie-in-the-sky dreamers are wondering. Imagine . . . imagine if an earthquake leveled every health-care facility in Southern California. Imagine what we could build. This, then, is their vision:

For starters, Southern California would lose about 200 its 260 hospitals. The 60 that remained would be perfectly dispersed across the region and would eat up much less of the health-care budget than hospitals do today. The job of the hospital would be a limited one: to provide short periods of intensive care to the sickest or most grievously injured patients. Most people’s health needs would be met in doctors’s offices or in one-day treatment and diagnostic centers.

“The house call is over,” declared David Rothman, director of the Center for the Study of Society and Medicine at Columbia University in New York, “and so, in many ways, is the local hospital.”

Gone, Rothman said, would be the highly personal relationship people have with their local community hospitals. Hospitalized patients might not even know the doctors treating them there. “It’s going to be the efficient interaction of strangers,” he predicted.

But there would be an upside to this cold, clinical world: The care for many would improve. Current distinctions between well-to-do and charity patients would be erased. “In the high-tech hospital, everybody is on the same level,” Rothman said. “We’re going to deliver to you the best medicine, whoever you are.”

Hospitals, clinics and other satellite facilities would be situated according to population needs, not by money-making incentives that concentrate specialists and medical centers in such affluent areas as Los Angeles’ West Side while leaving poorer areas with few choices. Everyone would have health insurance--without it, a system based on regional distribution of hospitals wouldn’t work.

The measurements of success would change.

Today, a hospital that makes money is considered successful even if the people it cares for don’t fare well and the community it serves has high rates of preventable disease. In the perfect health-care network, said health-care systems designer Jacque J. Sokolov, all parts of the system--hospitals and clinics, the people who care for the sick and the insurers who pay for the care--would be linked to one another. The system’s financial success or failure would be determined by the health of its community.

Sophisticated communications networks would be key, connecting hospitals directly to police, fire and civil defense command posts. Patient records--with such vital information as drug allergies or chronic illnesses or test results--could instantly be called up on a computer screen. That way, if a neighborhood hospital--or the freeways--went down in a disaster, people could be treated wherever they showed up.

Said Jeff Goldsmith, a health-care futurist: “You don’t need the freeways to be properly diagnosed or treated.”

Earthquake preparedness would be a must, said Stephen Gamble, president of the Hospital Council of Southern California. Medical facilities would be designed to withstand a magnitude 8 earthquake. In times of disaster, all would function as “lifeboats” with independent utility systems and a week’s worth of fuel, water and generating capacity for electricity and medical gases.

Will this vision work? Can it be achieved? There are many forces conspiring against it--inertia, turf battles, greed, lack of funds. But Zinner, the UCLA surgeon, said people at least ought to think about it.

“We can take this tragedy and turn it into an opportunity,” he said. “Is anybody asking the question, ‘Do we need to be what we were?’ ”