COUNTY GOVERNMENT : Sharing the Service Burden by Cultivating Grass Roots

Los Angeles County government’s experiment in regional social democracy is ending. The county’s decades-long effort to create a “little Sweden” is unraveling in the face of economic forces that have undermined public sector-oriented economies around the world. Ultimately, the county’s best hope is to develop a new, more decentralized system of providing services, while holding on to what it does best.

For years, county government, emboldened by what appeared to be an endless economic boom and a steady influx of federal dollars, assumed ever larger governmental burdens. To be sure, many of these services were mandated by Sacramento and Washington. But even as tax-weary citizens were enacting tough restrictions on their revenue-raising power, few officials in county government questioned the basic mission of providing more and more public services to an ever-expanding constituency.

The devastation of the wealth-creating parts of the regional economy during the past five years, resulting in the loss of more than 200,000 private-sector jobs, has left the county with little choice but to scale back its huge public-service bureaucracy and concentrate on those responsibilities--such as law enforcement--best handled by government. As did many private-sector firms during the early 1990s, it must then begin to form alliances with smaller, more entrepreneurial units that might be able to deliver services more efficiently and economically. In essence, the county would rely on a classic “third wave” model of service delivery--niche-oriented, small scale, decentralized and networked--in contrast with the “one size fits all” model of the “little Sweden” approach.

Such decentralized systems already exist in the business world, particularly in successful entrepreneurial industries like medical equipment, entertainment and high-technology electronics. In Hollywood, for example, informal networks among studios, independent producers and specialized-service firms allow for collaborative, efficient and timely development of entertainment products. Similarly, software and other high-tech companies thrive through informal linkages among venture capitalists, specialized consultants, specialized subcontractors and larger producers.

Perhaps even more relevant to a “reinvented” county government is a “third sector” of nonprofit organizations, which are not formed and held together by the federal or state mandates that determine most county activities. Rather, they are ethnic or cultural “communes” in the business of providing specialized services to their constituents.

Often these communal organizations fill gaps left by inadequate or unresponsive government policies. Gay communities around the country, including in Los Angeles, have raised millions to develop nonprofit institutions to serve the health needs of the HIV-infected population. Similarly, many ethnic federations and associations assist newcomers, socially and economically. For example, Jewish relief groups, although partly funded with public money, leverage their own community resources to provide immigrants from the former Soviet Union with everything from cars to job opportunities to English-language training.

Such assistance and concern spring naturally among people who share a history or culture. Much the same is occurring within the African American community, where churches such as Bethel AME Church, the Crenshaw Christian Center and West Angeles dispense not only spiritual guidance but assistance in computer training and job and entrepreneurial development. Bethel AME, for example, offers computer-training classes to youngsters and older congregants. Instead of using government trainers, the church’s program is run by black professionals in the data-processing field who volunteer their expertise.

Education represents one of the clearest expressions of the trend toward non-governmental solutions. Throughout the country, and especially in urban areas, parents are increasingly sending their children either to community-based charter schools or to those run by religious denominations. Although safety, control and quality are the main reasons for the exodus, many parents are shifting to such schools because they want morals and values directly taught to their children. This movement finds fertile ground in Los Angeles, where people increasingly reflect not one monolithic cultural perspective but a range of moral, religious or ideological views.

It is to such religious and communal organizations that society, as well as county and other urban governments, must turn to pick up the public-service slack. Some of these groups represent a modern renaissance of volunteer-driven health care.

Largely serving a population of poor, immigrant, homeless, runaway or “throwaway” children, the Los Angeles Free Clinic offers a cost-effective means of meeting their needs. Last year, it served more than 20,000 of the region’s most destitute persons with money chiefly collected from private sources and a mostly all-volunteer medical staff.

The average walk-in visit at the clinic, says director Mary Rainwater, costs roughly $30. A similar visit to County-USC ranges up to $200. More important, Rainwater believes the small paid staff and large volunteer corps of doctors bring a kind of commitment and compassion not often associated with a government-run institution.

“We have volunteers who want to be here,” explains Rainwater. “The environment we create is positive--user-friendly, if you will-- for people to come and get their health care.”

Although free clinics and other nonprofit organizations cannot supply all the medical services currently supplied by the county, Rainwater and other professionals see the county’s budget crisis as an ideal opportunity to restructure health care in ways that stress decentralization, preventive care and easy access. Rainwater says the county system--big hospitals and giant bureaucracies--is largely “obsolete” and should be refocused toward trauma care, which cannot be handled by smaller units.

At the same time, some health-care services could be delivered more economically and effectively from community-based HMOs, such as Inglewood’s United Health Plan and Montebello’s Viva Health. These organizations, principally operated by minority doctors and entrepreneurs, are better able to tailor their services to the needs of Los Angeles’ varied communities.

At Viva Health, for example, the physicians have a long history of involvement with Latino patients. Along with the HMO’s staff, they treat their predominantly young, family-oriented clientele with full knowledge of Latino culture.

“When we are talking about consumer responsiveness, we are talking about understanding the individual, we’re talking about true communities,” says Ruth Lopez-Williams, the chief executive officer of Viva Health. “Every community, every industry takes on its own dynamics which best serves its own community.”

In many ways, the enormous energies of the county’s ethnic and cultural communes are a modern-day equivalent to non-governmental associations that attracted the attention of Alexis de Tocqueville 150 years ago. In the America he visited, much of what is now done by government was performed by churches, community associations, business and other volunteer groups.

The shrinking of county government is certainly not going to happen without much pain. Many hard-working people will lose their jobs, as occurred in the downsizing of corporations and the defense industry. But if Los Angeles County wants to remain an economically and socially sustainable region, its government must extract itself from a 1930s time warp and draw its strength from a diversity of grass-roots service organizations better attuned to the demands of urban life in the next century.