Health Czar Races Clock to Save County’s System

His aides had barely finished slathering cream cheese on their bagels Sunday morning when Burt Margolin began bombarding them with questions.

Margolin--the bespectacled point man in the drive to keep Los Angeles County’s health care system from imploding--wanted to sort out what had happened the previous day, when the state Legislature torpedoed a package of bills providing millions in aid for the county.

Despite the state action, he still had a card to play: talks this week in Washington over a possible federal bailout. After a long discussion of how best to approach federal officials, an assistant posed a question to Margolin, making a small but telling slip: Was he coming back to Los Angeles after the talks?

Not when was he coming back, but was he coming back.

As other aides guffawed, Margolin smiled broadly. “If I don’t have a deal,” he said, looking around the crowded conference table in the county Hall of Administration, “do I even want to come back?”

Though outwardly glib, Margolin’s retort underscores the seriousness of his role as chief strategist and organizer of the county’s increasingly desperate quest for a federal and state rescue of its $2.1-billion network of hospitals and health clinics for the poor.

The former Democratic assemblyman from the Westside is racing an Oct. 1 deadline set by the Board of Supervisors to avoid closing 34 of 45 health centers and possibly up to four of six county hospitals to bridge a mammoth budget gap. On Friday, nearly 5,200 health workers were notified that they will be laid off or demoted unless additional funds are found in less than two weeks.

Margolin, 44, has been given sweeping powers by the supervisors to attempt to bail out and reform the much-criticized Health Services Department, headed by retiring Director Robert C. Gates.

But despite his extensive connections in Sacramento and Washington, observers give Margolin slim odds of being able to avert Draconian cuts in the department, which delivers medical attention to hundreds of thousands of poor people each year.

His chances are “much better than winning the lottery, but a little tougher than achieving peace in Bosnia,” said David Langness, a spokesman for the Healthcare Assn. of Southern California, a group of mostly private hospitals.

“If he saves it, he’s a hero,” said Langness. “If he doesn’t, he won’t be a goat because he was sent in to do a job that’s almost impossible.”

A soft-spoken policy wonk who has been compared to Woody Allen for his understated humor and who seems propelled by a bottomless supply of nervous energy, Margolin is almost uniquely qualified to serve as county health czar.

One of the Legislature’s most liberal members until his retirement last year, he was a member of the Assembly Health Committee for 12 years and served as chairman for two more.

He earlier had served as chief of staff to Rep. Henry A. Waxman (D-Los Angeles), the architect of numerous measures to expand federally subsidized medical care for the poor and elderly.

After an unsuccessful 1994 run for state insurance commissioner, Margolin was hired by a Century City law firm to head a new unit devoted to health care matters. He has used his political connections to stay in close touch with Democratic lawmakers in Sacramento and Washington throughout the county crisis.

He was tapped in late June by an old friend and Westside political ally, Supervisor Zev Yaroslavsky, to chair a task force created to find ways to keep deep budget cuts from eviscerating the county’s medical system.

After several weeks of intensive work, the group--composed entirely of health experts--issued a report that flatly rejected a recommendation by county Chief Administrative Officer Sally Reed to close County-USC Medical Center, the nation’s busiest public hospital.

“We thought it was a terrible idea,” Margolin said. “It sounded to me as if it was a retreat from the county’s mission to be a health care safety net and I, like many people in the community, was disturbed by the implications.”

Instead, Margolin’s committee said, the county should close 75% of its hospital- and community-based health clinics--a move that could be more easily reversed than shutting down hospitals if bailout funds materialized. Margolin further urged that private hospitals and physician groups be allowed to bid on taking over the clinics.

Meantime, he and other county officials launched a full-court press in Sacramento and Washington for more money.

Working with a staff of 25, Margolin’s life has become a whirlwind of staff meetings, conference calls and dashes to the airport. His staff includes four other members of the law firm he works for, Brady & Berliner, which the county is paying $175,000 for six months of work.

Margolin’s main goal this week is winning federal approval of a Medicaid waiver that would bring nearly $200 million in immediate aid for the county in the form of matching funds and more money for hospitals that serve large numbers of the uninsured poor. The waiver also would free the county to spend federal money earmarked for hospitals on more cost-effective outpatient treatment.

Intensive negotiations in Los Angeles last week with officials of the U.S. Health and Human Services Administration ended in disappointment for the county. But Margolin insisted that the county has a “serious chance” in this week’s talks in Washington--if only because the consequences of not getting the waiver are so devastating.

“No one who’s at that conference table is going to want to walk away and explain why we failed,” he said.

The son of a canned goods salesman and a homemaker, Margolin grew up on the Westside, attending Hamilton High School and UCLA, where he majored in political science but did not graduate.

Influenced in his early teens by a local rabbi who stressed the obligation of Jews to promote social justice, Margolin demonstrated against the Vietnam War in the 1960s. Still in high school, he helped Waxman win his first Assembly seat.

When Waxman moved on to Congress in 1974, Margolin became his chief of staff. Later, Margolin served on the staff of then-Assemblyman Howard L. Berman. Aided by the Waxman-Berman political organization, Margolin in 1982 made his own run for the Assembly, winning a seat representing Westwood, Beverly Hills and other solidly Democratic parts of the Westside.

Described as a “masterful, hard-working and low-key legislative technician with a clear, liberal agenda” by the California Political Almanac, Margolin soon developed a reputation for tackling seemingly intractable problems.

In 1986, he introduced legislation requiring deposits on beverage containers, even though the Legislature had killed at least 14 such bills over 20 years. But armed with careful research showing that deposit laws decreased litter and boosted recycling, Margolin brokered a deal between environmentalists and industry lobbyists, securing passage of his bill.

He also plunged into health issues, writing laws that expanded prenatal care for poor women and prohibited hospitals from “dumping” critically ill patients without health insurance.

He was successful in reversing insurance industry practices that prevented small businesses from buying medical coverage for their employees. He tried repeatedly but failed to win passage of universal health coverage for Californians.

“He was the leader of health care reform in the Assembly,” said E. Richard Brown, director of UCLA’s Center for Health Policy Research. “He played a critical role in moving the whole debate about health care reform up notch after notch.”

Last year, he quit the Legislature to run for state insurance commissioner, pledging to make health insurance reform a top priority.

His opponent in the Democratic primary was state Sen. Art Torres (D-Los Angeles), who had been twice convicted of drunk driving. Steeped in hardball Waxman-Berman politics, Margolin aired radio commercials calling attention to Torres’ record. Torres won anyway.

In July, Margolin’s task force recommended that the county appoint a health czar to spearhead the Medicaid waiver and financial rescue efforts. The committee also urged supervisors to set up a “health authority,” apart from its health department, composed of experts who would carry out health care policies.

Supervisors later named Margolin as health czar, and there has been talk since that he would make a good head of the as-yet-unborn health authority.

But Margolin insists that he has no interest in such a job, and that he will leave his health czar post as soon as his law firm contract expires.

“The board didn’t want someone to come in here and restructure the system with an eye toward being part of the system that’s being restructured,” he said. “My advantage to the board is that I come from outside the county, I’m here for a limited time, and I don’t intend to become part of the restructured system.”