We Need More Beds for L.A.’s Many Uninsured

Los Angeles County supervisors should be commended for their decision to construct a satellite hospital in the San Gabriel Valley, complementing the replacement facility for the aging County-USC Medical Center. This decision shows a growing recognition that inpatient care is a vital health necessity for a region that long has been neglected. Unfortunately, the satellite hospital does not put to rest the issue of how many beds are needed to replace County-USC.

In plans to restructure the county’s public health system, supervisors have appropriately decided to invest in an extension of community clinics that will provide primary care, preventive services and needed outpatient treatment. However, this change does not negate the need for a healthy number of inpatient beds.

There are more than 3 million uninsured children, women and men in L.A. County. This number is increasing by nearly 15,000 each month. And this astounding increase has taken place during an incredibly robust economy. Until we are able to arrest the hemorrhage of uninsured people, we need a public health infrastructure that will not crumble under increasing numbers of medically needy patients.

Also, due to cost, fear of being deported and lack of information, many poor residents probably have not been to doctors for years. As these people become aware of health opportunities, they will come in with needs for more than just preventive treatment that can be administered in outpatient clinics.

The number of inpatient beds needs to be able to meet this demand, whether through one replacement facility or the replacement and its satellite. Altogether, supervisors propose to have 660 inpatient beds, 600 at County-USC and 60 at the satellite hospital on the site of Legacy Hospital in Baldwin Park.

Seven studies completed on the subject recommend 750 beds. Medical professionals and public policy experts came before a joint legislative panel last month to support 750 beds. In fact, outside of the majority of supervisors, who favor a lower number of beds, there is no public support for fewer than 750 beds.

Some have tried to frame this issue as one of a relentless and self-interested posse of state legislators pitted against a forward-looking county board. But taking a look at the financing, one can clearly see that the state has a legitimate interest in its oversight. The state plays a key role, as it will provide nearly $265 million--almost 45% of the county’s net costs--to assist in the construction of the replacement hospital. As investors in this project, state elected officials must advocate fiscally prudent public policy.

Apart from the state money, the county is scheduled to get more than $100 million annually in tobacco settlement money for the next 25 years, not to mention the $450 million expected annually as a result of the state’s application for federal dollars to be given to the county. The county cannot plead poverty.

In addition, the county has a unique opportunity to stabilize the funding for its health department by marketing health coverage to organized labor in general, beginning with newly unionized, low-wage service workers who need quality health care at a reasonable price. Not only would these consumers generate new revenue, but they also would reduce the county’s dependence on Medi-Cal and medically indigent patients. These financial considerations lend further strength to the argument for bolstering all aspects of the health system.

Beyond the debate over funding and hospital size, there is the issue, arguably more significant, of developing a vision and commitment to quality health care. Movement toward a stabilized inpatient capacity, coupled with expanded outpatient care, would demonstrate the county’s commitment to do more than the bare minimum. The new County-USC hospital should not bear the stigmatized image of the past. What it should be is a state-of-the-art hub for health care, serving the dual purpose of providing vital training for professionals and needed services to the poor and working-class population of Los Angeles.

Access to health care directly affects people’s quality of life. Supervisors still have a way to go if they are to truly provide enough resources for families in need of medical attention. The situation will require something far more important than 750 beds: moral leadership and political courage. Only then will we ensure that all residents, regardless of income, are treated with the modicum of dignity and respect that they deserve.