Initiative in L.A.’s Health Care Crisis : Margolin’s approach holds promise of easing clinic and hospital shutdowns

Los Angeles County’s plaintive pleas for help in its budget crisis are undercut by a widespread perception that the Board of Supervisors is not doing enough on its own to address the problem. Some critics see the board’s attempt to obtain state and federal aid as nothing more than a bid for a bailout. However, under the leadership of health czar Burt Margolin the county is now taking a proactive and methodical approach in confronting the main part of its fiscal problem--a health care dilemma that is worsening every day. The key to that approach is public-private partnerships.

If Margolin succeeds, the most Draconian of the proposed health care cuts will be avoided in the near term. In the long term, the county would be on course for an overdue restructuring of health services.

But if the county cannot close the $655-million gap in its health budget, many public clinics and hospitals will be closed starting Oct. 1. That prospect is frightening.

Margolin’s plan operates on two fronts:

Public-private partnerships. The health official solicited bids from private hospitals and health care organizations to provide services that might be lost if six comprehensive county health centers and 35 county clinics are closed as slated. After analyzing 109 proposals from 75 organizations, Margolin began meetings with the top bidders, yet unidentified. The goal is to conclude negotiations very soon so that only some clinics, not all, will have to close.

Washington. This week Margolin is scheduled to meet with federal officials. He is seeking a waiver from federal rules that would mean $178 million more in Medicaid funds for the county. The waiver would allow the county to retain full federal funding while providing more efficient, less expensive care by using the outpatient approach now favored by most private hospitals. Federal law pays more for inpatient care, a condition that locks the county into its costly hospital-based health system. Washington’s approval of the waiver is needed by the Oct. 1 county deadline to avoid the hospital closures.

The federal money, together with the $50 million that the Metropolitan Transit Authority agreed last week to give to the county, would make up part of the health deficit. Sacramento could help further by approving administrative changes. Yet even with all this, the county still might face a shortfall of as much as $200 million. Clearly, major cutbacks would remain imperative.

Margolin’s innovative approach deserves a try and support from Washington, Sacramento and the county’s private sector. It signals a spirit of problem solving and a shift away from the political posturing under which the Board of Supervisors often takes cover.