County Health Care at the Brink : Washington must follow through with the aid it promised

Los Angeles County presents President Clinton the opportunity to test his administration’s grand vision of providing accessible, cost-efficient public health care. When the President pledged $364 million last September to rescue the county’s financially troubled health care system, it was to be the foundation for a five-year restructuring. Now that five-year plan, to be implemented as a federal demonstration project, may be in jeopardy because of bureaucratic foot-dragging in Washington.

Los Angeles County supervisors and health officials are scheduled to meet today with White House Chief of Staff Leon Panetta in the capital to salvage the rescue of the county system. At issue is the effort by the Washington health bureaucracy to implement year-one and hedge on the remaining four years of the promised aid. So the $364 million pledged for this fiscal year, which ends June 30, seems assured. But the Health Care Financing Administration is reluctant to sign off on the other four years because of federal budget concerns and a lack of confidence in Los Angeles County’s newfound willingness to demonstrate fiscal responsibility. That’s understandable, given the county’s free-spending past.

The key to the county’s plan is its waiver from federal Medicaid rules, which would allow the flexibility to shift federal funds now available only for expensive hospital treatment to pay for more efficient care in outpatient clinics. Washington should find persuasive the county goal to cut by one-third its 2,595 beds and increase access to clinics by 50%.

All federal waivers are granted for a period of five years. The one for Los Angeles County should be no different. HCFA’s waffling undermines what could be a nationwide model.

Federal officials have been hearing promises of change from the county since 1971, when it first sought federal help because of budget problems. Why should they believe the county is not crying wolf this time?

Because of Mark Finucane. The new head of the county Department of Health Services has finally brought a tough, no-nonsense oversight to the nation’s second-largest public health care system. He speaks candidly of the past mismanagement and lack of accountability in his department. He has put staff on notice that if they cannot accommodate the changes, they should leave. Finucane works well with the supervisors--but he also seems to understand that there are times when he must stand up to them too.

At the meeting today, federal officials would do well to remember that Los Angeles County can be used as a model for how government can reinvent itself. Or it can be another example of government’s failure to deliver services it promised.