The Los Angeles County Board of Supervisors lurches from crisis to crisis while the county marches toward meltdown: a lapse of federal waivers that by 2005 would leave its health department facing an estimated deficit of $884 million. By their own admission, the county supervisors did not step in to fix lethal problems at County-USC Medical Center until prodded by stories on the front page of The Times. If they wait for the headline "L.A. County Declares Bankruptcy," it will be too late. They need to act--now.
Soaring health care costs drove the county close to bankruptcy in 1995, the year the Clinton administration stepped in with the first $1-billion waiver of federal Medicaid rules governing outpatient care. The county had five years to restructure and cut costs. When it didn't, at least not enough, the federal government came through last year with an extension of the waiver--and a warning that there would be no more. The waiver will begin to taper off in 2003, leaving the health department with a projected deficit that year of $184 million.
Los Angeles County has more uninsured residents than any other county in the nation. Many are eligible for public health insurance, which would help keep the county afloat, but don't apply because the process is so complex or because of cultural and language barriers. The state and federal governments desperately need to streamline and expand Medi-Cal, Healthy Families and other programs that would help pay for this care.
A good deal of this crisis comes down to money. But actions--or inactions--by the county have made a dire situation worse. And the problems start at the top, with the supervisors.
Yes, they stepped in last week and fixed the crises in that week's headlines--delays in critical care at County-USC Medical Center and dangerous overcrowding in its psychiatric emergency room. But why should such ridiculously simple solutions as retraining nurses to deliver specialized care and opening up unused beds in other county hospitals have to go before the Board of Supervisors in the first place?
In a frenzy of finger-pointing, the supervisors blamed bureaucrats, unions and each other. But in truth, the supervisors' constant micromanaging has undermined the authority of department officials to make such decisions themselves.
Supervisors last year appointed a blue-ribbon task force, which became at least the second such task force to call for the obvious: an independent health commission or authority to oversee the health system.
An even more dramatic suggestion came out of a two-year study funded by the Public Policy Institute of California. Los Angeles County, the study says, is in even more dire straits than Orange County was when it declared bankruptcy in 1994. To meet its core social service obligations, including health services, it should consider dropping responsibility for providing fire protection and other municipal services to the 1 million people living in unincorporated areas.
Forcing residents in unincorporated areas to incorporate or contract with private or volunteer fire departments is a drastic step, probably too drastic. But it should at least convince the board that these times demand an urgent response. The supervisors should follow their task force's advice and direct it or another panel to develop concrete steps to restructure the health care system. Then they should set up the new governing structure and get out of the way.