Politics at Health’s Expense

While a task force looks into creating some type of authority to oversee Los Angeles County health services, county supervisors are doing their part to show why a new governing structure is needed. As Exhibit A, they inadvertently offer themselves.

The five-member Board of Supervisors is, of course, the current governing body. On Tuesday four of the five voted to draw up plans to expand Harbor-UCLA Medical Center and to study the need for expansion at two other county hospitals. That they did so in the face of a $1-billion deficit is only the half of it.

Supervisors Yvonne Brathwaite Burke and Don Knabe have lobbied for years to expand the emergency and operating rooms at Harbor-UCLA, which straddles their districts. They finally picked up the votes of Supervisors Mike Antonovich and Zev Yaroslavsky by pushing for a study not only of Harbor-UCLA but also of two hospitals that serve their districts, High Desert Hospital in the Antelope Valley and Olive View-UCLA Medical Center in Sylmar. Supervisor Gloria Molina (whose district is getting a rebuilt but downsized County-USC Medical Center) voted against the study, and County-USC got nothing.

Could anyone ask for a more blatant example of politics dictating health care policy? If so, this county could probably provide it.

With overcrowded emergency rooms turning patients away countywide, it’s a safe bet that all these hospitals could fill expanded facilities. But then they would also need nurses to staff the new beds and money to pay for the additional patients--not to mention the patients they see now--and there’s no sign that the nursing shortage is going away or that the federal government is coming through with generous new funding. In fact, the feds intend to cut aid, which is one reason the county’s situation is so dire.

Yes, supervisors are politicians, but the health care system is at best too complex and at worst too broke to be used to gain points from constituents or settle scores against colleagues.

Setting up a semi-independent agency to govern county health care would not solve the immediate fiscal crisis. But it would allow policy decisions to be made and scarce funds to be allotted based on a countywide assessment of needs, not on an individual supervisor’s ambitions.

Politics aside, a commission whose members had expertise in health care and whose single purpose was to make the health department work surely would offer better oversight than a Board of Supervisors that oversees more than 30 other departments. And judging from the supervisors’ notoriously touchy relations with past health department directors, a new governing agency would offer hope of better relations--and of attracting the best person to the top job.

The supervisors have appointed a task force to study setting up a commission, but they did that in 1995, the last time health care costs almost drove the county to bankruptcy, and then shelved the recommendations. The county can’t afford to miss this chance again.