County’s Health Crisis Is Everyone’s Problem : Los Angeles: It will take business, government leaders and citizens working together to save the social safety net.

Oct. 1 will be a defining moment in Los Angeles. If $330 million in bridge financing is not found, up to four county hospitals could close. When added to the closure of county outpatient clinics already under way, the hospital closures will endanger public health, collapse the trauma network, leave 2.6 million people, most of whom are working poor and their families, without access to care, and almost certainly cause the closure of emergency rooms throughout the county.

So far, what is most striking about this crisis is our response as a community. This is a crisis that nobody thinks is their problem. Until everybody living or working in Los Angeles County realizes that the causes of this crisis are our collective responsibility and that we have a community stake in solving it, we will not secure bridge financing nor will we have the civic will to stay the course during a restructuring of public health care that will take years to accomplish.

What must we do as a community to avert collapse of the county health care system?

* Board of Supervisors: Now that the supervisors have unanimously adopted the Health Crisis Task Force recommendations and appointed a health czar, they need to have the political courage to be fiscally prudent and to restructure the system. The health czar is a crisis manager; a quasi-independent health authority must be established to develop and manage a public-private system in the long term.

* Mayors and city councils: Los Angeles’ mayor was successful in blocking the multiyear transfer of funds from Metro Rail to health care (an issue of legitimate disagreement). MTA’s decision Thursday to give $50 million to the county is a one-time action.

Most cities have been too silent locally on behalf of the poor and too absent in Sacramento and Washington, where the funding decisions are made. Failure to provide access to mental health and medical care will create problems in every city. Cities must help attract new revenue in the short term. Longer term, cities and counties must work together to deliver services in a more cost-efficient and responsive manner.

* Health professionals: The medical and allied health professions, along with our educational institutions, must be full partners in transforming the current system to one that is based on prevention, out-patient care and family medicine. A restructured cost-effective system must also provide access to quality care. The rapid response of private providers to the county’s request for partners is promising. Private physicians, hospitals and plans that attract Medi-Cal patients in large numbers should also assume some proportionate responsibility for indigent care.

* Business community: Business leaders should recognize that our changing economy is in part responsible for this crisis and that business has a stake in solving it. Between 1990 and 1993, 300,000 fewer workers had employer-based health care. Additionally, the new managed care delivery system has successfully controlled costs of care and, at the same time, virtually eliminated one historic source of funding: shifting costs from those with coverage to those without.

The business community has to provide leadership as we seek long-term solutions. The Los Angeles Area Chamber of Commerce has taken helpful steps and now, with the county, should convene a separate task force to address the needs of close to 30% of the county’s population, the 2.6 million medically indigent, legally resident, predominantly working poor and their dependents.

* Religious leaders: The voices of our clergy must now be heard. Access to health care for all people has been a cornerstone of the social safety net for more than 50 years. Dismantling the safety net is a moral as well as political issue. Is it morally acceptable to deny access to health care for the poor?

* Citizens : The people of Los Angeles County have a critical role to play. The governor, state legislators and our congressional delegation need broad-based public support if we are to obtain the most federal and state dollars for Los Angeles. Only with public support now will the county obtain bridge financing so it can restructure the public health care system. Citizens must also hold the county and cities accountable for their performance in implementing a reform agenda.

Up or down for Los Angeles? It’s our choice.