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Hope on Health-Care Front

Los Angeles County’s infamously tax-averse voters surprised everyone by approving a property tax increase last month to keep the county’s overburdened trauma and emergency-care system operating. The vote may also have created the momentum to salvage the rest of the county’s troubled health-care system.

Gov. Gray Davis called a news conference two weeks ago to announce that state and county officials had finally agreed on a request for federal aid for the network of hospitals and clinics that serves the county’s huge low-income population. The Bush administration had resisted working with just the county, insisting that the state get on board. Now that it has, federal Medicare and Medicaid Director Tom Scully is scheduled to talk with local officials today.

The state and county are asking the federal government to waive certain rules on how the state may spend federal Medicaid dollars. The county received a waiver in 1995 and again in 2000 to get through an earlier crisis. The federal aid, however, tapers off each year; that decline would leave the county with a deficit of hundreds of millions of dollars by 2005.

As the tale is usually told, the county is in so much trouble now because it failed to make the reforms called for in the earlier bailouts. By shifting patients from costly hospitals to less expensive outpatient care, the county was supposed to save money that could then be used to keep the system running without additional federal help. The savings didn’t materialize. But a respected study confirms that the county did make reforms. A 2001 evaluation by the Washington-based Urban Institute cited new public-private clinics, reduced emergency room use, a reduction of hospital beds and improved efficiency. What prevented the expected savings was the sheer number of new people without medical insurance seeking care at county-run clinics and hospitals.

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“Absent some broad federal or state health reforms that substantially reduce the number of uninsured in Los Angeles,” the report said, “the demands on the county to meet the health-care needs of its low-income population are enormous.”

The new waiver requests are based on programs that the Bush administration already has approved elsewhere, allowing more flexibility in the use of federal dollars to treat the poor. Admittedly, these would be short-term fixes that would not begin to touch the problem of 6 million Californians without medical insurance, more than 2 million in Los Angeles County alone. The county cannot begin to fix that on its own. With a helping hand, however, it can keep the system afloat until the nation begins a much-needed debate on a broken health-care system.


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