A Brief Remission

Everyone take a bow. With great fanfare, the politicians announced they had found lots of new money to fix Los Angeles County’s health-care crisis: $170 million from Measure B, $150 million from Washington, $100 million from Sacramento.

And so public health has dropped off the public radar screen. But the basic problem hasn’t been solved or even addressed. We have too many uninsured people and too small a public system of clinics, hospitals and public health.

Our county health budget is decided by politics rather than the predictable health needs of our population. That’s why the current “solution” is both doomed and dangerous. And we all -- rich and poor, insured and uninsured -- are at risk.

The county supervisors say they won’t have to close Harbor-UCLA or Olive View-UCLA hospitals for now. So although they “saved” these two, they’ve taken High Desert and Rancho Los Amigos hospitals out of their budget, to be sold, closed or operated by some as-yet-unnamed “foundation”; and they plan to reduce L.A. County-USC Medical Center capacity by 100 beds.

That’s a loss of 270 county beds, which comes on top of 750 pulled out of service from 1995 to 1998. And it’s in addition to the closure of 11 clinics (500,000 annual visits); a 25% cut in funding of so-called public-private partnership clinics set up in 1995 to cover cutbacks then; and a 10% cut in critical public-health and disease-surveillance budgets.

These actions have come without any reduction in the numbers of uninsured and with no estimate of the effect on the health of the overall population and no response to deep concern and public warnings from responsible people at required public hearings.

If we accept this precedent, we agree it’s OK to base our health-care budget on what is politically expedient rather than on the health-care needs of our people.

We agree to reduce our health-care safety net without ever addressing the unprecedented numbers of uninsured who rely on the safety net.

We agree that officials can hold legally required hearings, hear unanimous and universal rejection of a particular course of action -- and take that action all the same.

We agree that it’s OK for the county to avoid its legal obligation to care for the poor and uninsured.

That’s what’s going on in our community. The Los Angeles County Medical Assn. has repeatedly asked officials to show how their cuts won’t harm patients or collapse the health-care system. The requests have been ignored.

What’s a doctor to do? What do you do when public policy and process threaten the health and safety of your community, and the officials in charge ignore valid concerns?

You stand in support of a lawsuit just filed by a coalition of public-interest lawyers, and you bring the California Medical Assn. with you, asking for an injunction to stop the dismantling of the county health-care system.

You get a judge to listen when federal, state and local officials won’t.

You ask the judge to pose the questions in court that the officials ignore in public hearings, and you ask a judge to decide whether the actions are legal.

We must either increase the funding for our county system until it meets legal requirements as well as public health and safety needs or we must reduce the numbers of people relying on that system. Failure to take one action or the other will bring further reductions in the county system, making it even more inadequate, and that will adversely affect the private-sector health-care system as well.

Yes, some other things on the budget may have to be cut. But we elect politicians to set tax rates, write budgets and make sure our systems meet legal requirements and are consistent with our values as a society. In this case, they haven’t done so.

And when they ask us, who question them, how we would solve the problem, they are disingenuously dodging their duty.

If, alternatively, we decide we want a Third World health-care system in Los Angeles, then that decision should spring from a public debate and conscious choice, not a political sleight of hand.