Health Safety Net Is Fraying

Contrary to what many believe, UCI Medical Center -- Orange County’s only university medical center -- is not the county hospital. In fact, Orange County does not have a county hospital. Yet the Board of Supervisors is still legally responsible for providing emergency health care to unfunded patients.

County residents have depended on UCI Medical Center as a resource for patients for more than 25 years, regardless of their ability to pay. Nevertheless, UCI Medical Center alone cannot continue to bear most of the cost of indigent health care.

In many years of public service, from state senator to member of the Board of Supervisors and secretary of Child Development and Education, I have seen Orange County continue to make indigent health care a very low priority.

Funding for the Medical Services for Indigents (MSI) program has been provided at appallingly low rates. UCI Medical Center and the other 24 hospitals that contract with the county to provide MSI cannot continue to subsidize the county’s very clear legal and ethical obligation. Orange County’s excellent community clinics also cannot, and should not have to, fulfill the county’s mandate without adequate compensation.

The Board of Supervisors recently voted to spend an additional $2 million on MSI, bringing its total commitment to $47 million for the fiscal year. This is like throwing a glass of water on a house fire. It is widely acknowledged in the health-care community that the county must at least double its current spending to make MSI a viable, comprehensive program. However, our supervisors choose to ignore health issues in favor of long-term debt reduction.

We are all aware of the lagging economy’s effect on government at the federal, state and local levels. As a former supervisor, I can certainly appreciate the fact that Orange County will not be able to spend as freely as it has in the past.

However, the MSI program has never been adequately funded, and it is time for supervisors to rectify the situation. I am embarrassed to say that this county spends less per capita on health care than all but one other county in California. In one of the wealthiest counties of California, it is unfathomable that health care is not a higher priority.

The supervisors must repair Orange County’s already unstable safety net of health care for the uninsured and underinsured by allocating significantly more funding toward that end. With the federal and state governments implementing or considering cuts in funding for hospitals that provide a disproportionate share of care to indigent patients, it is imperative to shore up the safety net.

Los Angeles County’s health-care crisis has been termed “a meltdown” by Jim Lott, executive director of the Healthcare Assn. of Southern California. Because of this crisis, the county-run hospitals and clinics faced severe cuts and possibly closure. But voters overwhelmingly supported and passed Measure B, which will provide much-needed funding to L.A. County’s faltering emergency and trauma network. They were inspired by the possibility that they or their families might not get needed care because the system was inadequate.

We cannot afford to be shortsighted with regard to public health. As it is affecting our neighbor Los Angeles, this issue affects us all and is not limited to the indigent people who depend upon the MSI program. Without changes, Orange County will suffer the consequences of the MSI system’s inadequacies in the form of increased incidences of communicable disease infection, business losses associated with missed days of work because of illness, and increased waiting times in emergency rooms because of patients using emergency rooms for their primary care needs. Our supervisors must act now to prevent irreparable damage to Orange County’s health-care system.

As a start, the county must put more money into the MSI program. Supervisors must reorder priorities and find additional funds to meet the county’s legal obligation.

That may mean reallocation of dollars. Funds follow commitment even when things are tough.

Improved reimbursement for services will ensure greater participation from Orange County physicians, clinics and hospitals and the creation of a better community-based system of care. If we do not take preventive steps, we will be in a quagmire similar to that of the county public health system in Los Angeles County, and that will be a problem for all residents of Orange County.