Health System Needs a Hero

Tom Scully is a reluctant hero. The Bush administration’s health honcho is scheduled to visit Harbor-UCLA Medical Center today but has shown little interest in saving Los Angeles County’s imploding health-care system. The Clinton administration bailed the county out twice, but Scully works for a Republican president who neither owes nor expects favors from a heavily Democratic county.

Besides, Democratic and Republican campaigns alike avoided health-care reform as too demanding, even as Tuesday’s election fell during open-enrollment season for many company health plans. Today the lucky politicians are out partying and the lucky voters are back to figuring out which services their soaring premiums will still buy. The unlucky ones -- an estimated 40 million Americans -- don’t get to gripe about their employer-sponsored medical insurance because their employers don’t offer any.

With its burgeoning immigrant population, Los Angeles County leads the nation in uninsured residents. This is the root of its health-care crisis. Small companies, service industry jobs and sweatshops support a vast population that makes too little to pay for individual insurance but too much to qualify for public programs like Medicaid.

The United States relies on employer-sponsored insurance to cover medical costs, and that works in Wisconsin, where just 20% of residents are not covered. But what passes for a national policy on health care doesn’t work in California, where, according to a 2002 Urban Institute report, 40% of residents lack employer-sponsored insurance. Los Angeles County hospitals, which treat residents regardless of their ability to pay, are overwhelmed.

The county Board of Supervisors, desperate to close a staggering systemwide deficit, will decide this month whether to close Harbor-UCLA. Scully has argued that to give Los Angeles County additional money would be unfair to states other than California. It would be -- if other states faced the same need. They don’t.

There are plenty of sound political reasons for a Republican administration to help Los Angeles County’s uninsured. An administration committed to homeland defense must recognize that the nation’s second-largest city is a possible terrorist target -- and that the county’s emergency-care and public health system form the backbone of response. And a Republican Party that in California is seeking to expand its base should be savvy enough to see that many of the low-income workers affected by county health-care cuts are in a coveted, growing group of voters -- Latinos.

L.A. County needs heroic action from Washington: First, the literally lifesaving money it can provide if it wants to. Then, new thinking on how to meet the health needs of this and other growing states.