Health Care Woe: Break the Cycle

Los Angeles County’s emergency and indigent health care system is trapped in a self-destructive cycle--bailout-cutbacks-crisis-bailout--largely because leaders at all levels of government have failed to work together, and with the private sector, to identify and implement public health reforms.

A 13-hospital trauma network, which provides emergency medical care to Los Angeles County’s 2.7 million uninsured residents, was pulled back from the brink in a $1-billion federal rescue in 1995 and then, last summer, by a $900-million bailout. Even so, county health officials say they have to drastically limit services because without sharp reductions now they will be looking at a half-billion-dollar deficit in five years.

Times health writer Julie Marquis recently described the wrenching consequences of the county’s frayed health care safety net: people near death because of untreated diabetes, for instance, and county home health care workers unable to pay for medical attention for their own children. The county has to get down to solid reforms, and there are plenty of places to start.

* A model for success. Los Angeles County’s modest expansion of community-based health clinics has not been nearly enough to decrease demand and costs at county hospitals. Members of the county Board of Supervisors cite as insurmountable problems a huge geographic area, high immigrant population, inability to assess taxes and lack of direct funding from the state. Those same obstacles, albeit lesser in degree, did not stop Hillsborough County, Fla., an 1,100-square-mile area including Tampa, from overhauling its health care system in a way that has become a national model.

In the late 1980s, Hillsborough’s hospitals and trauma centers were overwhelmed by indigents with once-minor health problems that had escalated into life-threatening crises. Hillsborough County persuaded the Florida Legislature to approve a local sales tax in 1991 and used the money to contract with private health care providers to cover all care for low-income residents, from eyeglasses to emergency room services. Hillsborough County also requires aggressive case management--contacting people who failed to show up for medical appointments, for instance. In the last six years Hillsborough County has seen its average length of hospital stay decline from 11 days to five.

* Management reforms. Look to San Luis Obispo County, which created an independent board of health department supervisors. Such a body could track every aspect of L.A. County’s huge Department of Health and Human Services, lifting the responsibility from an overextended five-person Board of Supervisors.

* State help. Gov. Gray Davis should allot state funds to expand the state’s Healthy Families program, which now covers children of the working poor, to their parents as well. Federal matching funds would cover two-thirds of the cost. Davis should also support legislation--rejected last year--to facilitate enrollment in public health insurance and to strengthen state penalties against private health plans that fail to pay the county’s trauma emergency rooms for providing care to insured people.

* Federal coverage. Congress should implement a bipartisan health reform proposed last month by interest groups that spent the last two decades at loggerheads--the consumer group Families USA, which supported the Clinton administration’s quest for national health insurance, and the Health Insurance Assn. of America, which helped defeat the Clinton plan. Their joint plan would use federal tax credits to help guarantee health care to adults and children in families with incomes up to twice the poverty level.

Given such clear models for reform and the increasingly high costs of doing nothing, elected officials at all levels are morally and fiscally bound to act.