Shortsighted Health Care Policy Has System in Critical Condition

The county’s health care system is in a crisis.

Last winter’s influenza epidemic confirmed predictions that the system no longer can handle the demands of 2.7 million Orange County residents, nearly 20% of whom have no health care coverage. What does this mean? It means people access health care via emergency rooms and they wait until they are very sick.

Hospitals, physicians and other health care providers maintain that the worst is yet to come if something doesn’t change. Sweeping changes are necessary and long overdue.

Most counties maintain a county hospital system. In fact, state laws mandate that counties provide services for those in need. Yet, Orange County sold its hospital and two county clinics a quarter-century ago to UC Irvine, which joined UC Davis and UC San Diego in purchasing county facilities.

At the time, it seemed like a good idea. The schools needed teaching hospitals for young residents; the county was looking to streamline services. There were good intentions but, for Orange County, the end results proved disastrous.

What happened? Orange County pulled money out of the very system it is obligated to support. There was a lot of finger pointing. The county didn’t like the way UCI was operating the hospital, although by most accounts the county’s performance was also questionable.

How could the county justify cutbacks when it knew what it took to run the hospital? For example, the county’s contract specified an agreement by the county to pay for indigent care. This requirement was quickly ignored. The level of county dollars dropped fast. In contrast to the other two hospitals, Orange County pulled away from an obligation.

Shielded by state and federal laws requiring hospitals and emergency physicians to treat patients regardless of ability to pay, the county shifted its responsibility onto the private sector. If the county were still operating a hospital the size of UCI Medical Center, the cost would exceed $100 million per year in general fund support. Right now, Orange County’s general fund spending is just $32 million.

This is an understatement of true costs forced on our private physicians, hospitals and nonprofit community clinics. Soaring uncompensated care costs have forced hospitals to absorb millions, over $175 million last year alone. Given the huge liability risks and high insurance rates, it is no wonder that there is a shortage of health care professionals.

How does this affect all of us? Well, in January when thousands of people were rushing to emergency rooms to be treated for often life-threatening flu symptoms, waiting rooms were full and doctors were scrambling. There are many people, especially senior citizens, who have difficulty even finding the transportation to get to their medical appointments, putting extraordinary stress on an already overstressed system.

What this really means is that the private sector pays. Businesses pay increased premiums for health care due to the misplaced burden. Citizens pay more as businesses offset their increased costs by passing them on to employees in the form of higher co-payments and deductibles, imposing limitations on choice of health care provider and increasing costs for employee dependent coverage. Uncompensated care is causing many private physicians and hospitals to practice and operate in the red. In fact, some hospitals have closed, unable to shoulder the costs for the county’s obligation.

Investing in health care is money well spent. A simple example: Increased access to community clinics would reduce the burden on emergency rooms and lower the costs of treating patients. It’s simply common sense.

Yet, out of the 10 most populous counties in California, Orange County spends the fewest net county dollars per capita for inpatient/outpatient services. Sacramento spends more than twice as much and Los Angeles more than four times what our county spends.

Healthy employees are productive employees. With the economy purring along and a new stream of tobacco settlement money, Orange County has an opportunity to fix its ailing health care system. The tobacco litigation settlement will provide the county with more than $700 million over the next 25 years.

The citizens of Orange County will have the right to vote on a health care funding initiative in November. The initiative calls for the lion’s share of the tobacco settlement dollars to be spent on critical health needs identified by the county’s own assessment.

Polls show voters overwhelmingly want the settlement money reinvested into health. It is time for the Board of Supervisors to listen to constituents. The county should do the right thing and invest the money in healthy families. Let’s not repeat the last 25 years.