PERSPECTIVE ON THE L.A. COUNTY BUDGET : Don’t Risk Health to Balance Books : There are no more resources to fill the gap--for rich or poor--if County/USC Medical Center is closed.

Two years ago, when Gov. Wilson first proposed balancing the state budget on the back of the county property-tax base, some predicted that resulting reductions in county health services would affect far more than the medically indigent and would, in fact, seriously affect the health of every citizen. That prediction is about to come true. Sally Reed, the chief administrative officer of Los Angeles County, has proposed that County-USC Medical Center and other heath centers be closed to save more than $600 million to balance the county budget for 1995-96.

There may be some in our community, including elected officials, who will say, “Oh, well, so a few poor people will have to travel farther for health care.” But every one of us will be affected. In short order, all our hospital-based trauma centers and emergency rooms will be disabled. Even if the 911 line is still answered, there will be virtually no place for any citizen, rich or poor, to be taken for emergency services. In addition, our remaining capacity to care for acute burn cases will be overwhelmed. The treatment of one-third of the AIDS patients in the county will be jeopardized, and the source of diagnosis of nearly half of all new tuberculosis cases in the county will have disappeared. All this is on top of the loss of essential health services for literally hundreds of thousands of the uninsured and medically indigent.

Still, one might say, it won’t be so bad. We will simply pay the private sector to do what the county used to do. But the hard fact is that each year County-USC Medical Center receives nearly $200 million in state and federal funds to help pay for these services. The money will not go to private providers because few are eligible.

Because of the enormous burden of uninsured people in Los Angeles County (31% of everyone under age 65) and the structural changes that have occurred in the funding of private health care in Southern California, the private sector does not have the resources to simply step forward to fill the gap in services.

A computer-based planning model (the L.A. Model) for hospital beds and emergency care in Los Angeles County was recently developed. It takes into account changes in our population and economy, identifies institutions at risk, changes in use of hospital beds and emergency rooms and changes in the makeup of health insurance, both public and private.

Using the L.A. Model to predict the effects of the closure of County-USC Medical Center, the result for central Los Angeles County’s 2.5 million people was an annual shortage of more than 750,000 emergency room visits and 1.15 million doctor’s or clinic visits. Since the medical center only provides about 700,000 of those lost visits, why should the loss be so large?

The answer is at once complex and simple. In Los Angeles County, we have already lost nine of 18 private hospital-based trauma centers since 1982, leaving just nine private and three county trauma centers in a system that serves 9.2 million people. County-USC Medical Center provides 28% of all trauma care in the county.

In addition, 18 of 105 private hospital emergency rooms have closed since 1982. The reason is the growing load of unpaid care that the hospitals are required to provide. They are required by law to accept anyone who arrives at their doorsteps. The only place that the 2.6 million medically uninsured in L.A. County can be sure to get care is an emergency room.

Should we lose County-USC’s emergency and trauma capacity, we will find that the capacity to replace those services, even if there are funds to pay for them, simply does not exist in the remaining private hospitals.

The remaining private institutions will also be so swamped with patients with no medical insurance that they will be unable to afford to provide emergency care and will have to close their doors. This will lead to a similar loss of services throughout the county in a domino effect.

Whose responsibility is this? The Board of Supervisors? The governor and state Legislature? Congress and the President? Some responsibility lies at all levels. But it will be impossible for the county to maintain even a vestige of its current services, including its emergency services, without additional resources from Sacramento and Washington. It is time that the political games being played in those places be replaced by serious efforts to return those property taxes and Medicaid funds, which we have already paid, to Los Angeles County.

Finally, this is an issue that involves the very structure of our community. It is a matter of critical importance to our elected officials and our health care community. But it does not stop there. It must be a critical matter to every business in Los Angeles, to our education system and to every citizen.