HMO Plan Merits Study

In Ventura County, no working person should have to go without health insurance.

However, tens of thousands do. Earning too much to qualify for public assistance but not enough to pay costly insurance premiums, they must borrow heavily or flirt with bankruptcy when serious illness occurs. Instead of heading for the doctor’s office at the first signs of trouble, they delay, hoping to spare themselves a hefty bill. By the time they finally seek help, they are often much sicker than they would have been with insurance to pick up the tab.

So when county officials last week floated an idea to help uninsured workers, they were targeting a serious, chronic condition that has gone untreated for too long.

The idea seems simple: The county has its own HMO, established for its employees six years ago over the protests of private hospitals and doctors. Under a proposal from Supervisor Frank Schillo, businesses that don’t offer health insurance to their employees would be able to provide it through the county’s HMO.

The idea, which requires months of research before its formal consideration by county supervisors, raises many questions:

* Will rates be affordable for small-business owners and their employees? Local restaurants, auto shops, dry cleaners and janitorial services often operate on the slimmest of margins; can their owners be persuaded to increase their overhead by joining the county’s HMO?

* Will the county’s deal be more attractive to small businesses than a similar arrangement offered by the state?

* Will the county require participants in its HMO to be treated by county doctors at county clinics and the Ventura County Medical Center? If so, just how many pieces of heavy artillery will the private hospitals wheel into position before launching their assault?

For eight years, an ugly hospital war has divided the county’s medical community, with Community Memorial Hospital and the Ventura County Medical Center each bitterly contending that the other is trying to drive it out of business.

In 1994, Community Memorial unsuccessfully sued the county over its new HMO, claiming unfair competition.

In 1996, Community Memorial blocked the county hospital’s proposed $51-million expansion.

Last month, it lost in its $2.3-million effort to pass Measure O, which would have given it and several other private hospitals the county’s $260-million tobacco settlement.

As for including the working poor in the county’s HMO, Community Memorial has indicated a willingness to consider the idea--but only if the county doesn’t force patients to use county health facilities exclusively.

Whatever form it finally takes, the idea is worth exploring both on humanitarian and financial grounds; no matter who provides the care, it costs less to treat a bad sore throat than to hospitalize a patient for pneumonia.

Our working poor deserve health care they can afford. If the county and Community Memorial can set aside their history of acrimony for this purpose, they’ll be healing more than themselves.