Just Right for County-USC

In choosing Wednesday to replace earthquake-damaged County-USC Medical Center with a new 600-bed hospital, Los Angeles County supervisors took a vital and proper first step toward resolving the region’s most pressing health care dilemma.

The 750-bed facility proposed by county health director Mark Finucane would have strained the county’s already-strapped health care budget. The 600-bed facility will enable the county to stay on solid financial footing while not forsaking its obligation to serve those who lack the public or private insurance necessary to get health care elsewhere.

Given that County-USC treats 830 patients each day, the county will inevitably have to shift patients into private hospitals and outpatient clinics. Some can be treated at the 152 community-based clinics the county has established in the last two years, for County-USC still admits as inpatients many who could be treated better and earlier in the clinics.

The county’s greatest challenge will lie in contracting with private hospitals to care for the overflow of indigent patients who now show up at County-USC and the county’s four other hospitals.

Finucane has offered to pay private hospitals competitive rates if they agree to treat indigent patients when county facilities cannot handle them. Private hospitals, however, want the county to pay them not only for the indigent patients it transfers to them but for the ones they currently treat. The private hospitals’ argument is disingenuous, for they already receive federal “disproportionate share” funds for treating indigent patients. The county will have to play hardball--that is, work with Washington to threaten to reduce the federal funds. That could persuade private hospitals to agree to a deal.

Over the long term, given L.A. County’s 2.7 million uninsured people, health officials will be able to meet regional care needs only if they work with state and federal officials to streamline public health insurance and increase coverage under private insurance plans.

One important step would be for state or federal officials to give tax credits to small businesses to encourage them to pool insurance costs and risks in order to provide affordable insurance to their employees: A majority of those uninsured in the county come from working families.

Until the working poor have access to basic health insurance, everyone will pay the price, through higher premiums, through higher emergency room costs and through communicable diseases that know no economic boundary.