Clinton Delivers on Health Care; Can the Supervisors? : With some breathing room offered, L.A. County has to get its act together

President Clinton has delivered a $364-million rescue package that will help hold together Los Angeles County’s troubled health services, but the system will never be the same. Indeed, reform of the nation’s second-largest public health system is the unequivocal goal of the federal aid. The big question now is whether the County Board of Supervisors can do the job.

Los Angeles County is grateful to the President for his help in averting a massive shutdown of health facilities, which was just a week away. Little applause, however, can be directed at the supervisors, who have not earned much credit in the effort to resolve the crisis. To avoid making tough decisions on their own, they appointed an emergency health care task force and a czar to come up with ideas for remedies.

The czar, Burt Margolin, was the architect of the complex proposal on which Clinton acted, and, accompanied by county and state officials, the former Democratic assemblyman from the Westside pushed it in marathon talks with officials in Washington as the clock was running down.

The key victory was winning a waiver from federal Medicaid rules. This change means that all six county hospitals and most of the public clinics will remain open, but some services will have to be cut. And most important, the county will be allowed to use federal funds now available only for hospital treatment to pay for the care of patients in clinics.

The new flexibility will help to wean the county off its expensive, in-hospital system and move it toward more cost-efficient outpatient treatment. “The plan is structured around a five-year federal waiver that will allow the county to restructure its health care system in a rational and planned way,” Clinton explained during a press conference at Santa Monica Airport on Friday, midway into a political swing through Southern California.

Another piece of the Margolin plan involves private hospitals and medical groups providing health services at some health centers and clinics. The private sector, which has the interest and capacity to help in restructuring, recognizes that the crisis is not over despite the approval of federal funding. “It’s not a bailout, it’s just a finger in the dike. This gives us a little bit of breathing room to reconfigure, redesign and retool the L.A. County health care system, which is a huge, huge task,” said David Langness, spokesman for the Health Care Assn. of Southern California. Negotiations with interested parties, which began before the Washington talks, are continuing.

Margolin has indicated that he will step down as health czar when his law firm’s contract with the county expires. Who then will oversee the restructuring? No successor has been named for Robert C. Gates, outgoing director of county health services.

A public microscope will be placed on the Board of Supervisors as it attempts to follow through on the overhaul. It will be a difficult task, and the supervisors must rise to the mission and take some political risks for once in this ordeal, especially in light of the possibility that some health jobs still will be lost now or later.

Complicating an already complex situation is the fact that contracts with unionized county workers expire soon. The supervisors criticized last week’s work stoppages by nurses at County-USC Medical Center, but will they stand up to county workers who may be inclined to block or thwart restructuring?

There is a plan on the table for immediate relief and long-term reform. But while the rhetoric of downsizing is easy, the implementation is not. Still at issue is the state offer of a $100-million loan, which the board has said it will reject. The prospect of tough choices led to backbiting and finger-pointing as the crisis mounted in recent weeks. The supervisors should acknowledge their failure to act with a single purpose. If they can’t do it now, they had better keep Margolin’s phone number handy.

The crisis has eased, but should the county find itself in a similar situation a year from now because of delays and dithering, the supervisors should expect to face some hostile voters when next they face election.