Perilous Inertia in Health Reform

Los Angeles County supervisors surely recognized last July that the county had to begin restructuring its health services immediately. Only an eleventh-hour federal/state bailout had averted a probable county bankruptcy that would have crippled care for the uninsured poor. So why is the relationship between county hospitals and independent clinics still fragmented, with no coherent plan for savings or for moving cases from costly hospitals to clinics?

Tuesday, for instance, an update from the county’s blue-ribbon health task force on restructuring care was put off at least three weeks, adding to a deepening sense of inaction and indecisiveness.

July’s bailout was the second time the Clinton administration pulled Los Angeles County from the fiscal brink, in this case with a five-year, $900-million Medicaid waiver. Without a major shift, deficits will return after the 2002-03 fiscal year and soon reach hundreds of millions of dollars.

An outsized and growing population of medically uninsured residents is only part of the problem. The relationships among the supervisors, county health department administrators, county staff members and the task force are marred by distrust and lack of communication.

When the county task force first reported to the board last September, it said, “We are concerned that our work will not result in change.” However, the supervisors had expected a blueprint from the task force and didn’t get one. Supervisor Don Knabe said he had wanted to thank the task force for hard work but couldn’t because “the hard work wasn’t done.” Dr. Patricia Matthews, a task force member, replied that her panel had been limited by “a very, very narrow scope of work . . . re-engineering in the county hospitals as opposed to the larger [health care] system.”

Atop all this are long-standing and perhaps irreparable strains between the supervisors and Health Services Director Mark Finucane.

Even so, the county could begin turning this debacle around. The supervisors have the authority to replace Finucane. But if board members believe that the fiscal situation is too daunting and the time crunch too severe to start over, they need to quit backbiting and offer Finucane guidance and support. Finucane must prove he can provide clear, persuasive plans and carry them out. The task force or some other panel needs to examine the county’s huge and complex health care delivery system as a whole. Only with solid progress on all these fronts can the county avert a disaster just two fiscal years away.