Health Debate Takes Shape

Los Angeles County’s overburdened health-care system will survive to collapse another day, Health Services Director Thomas Garthwaite told county supervisors last week. Painful budget cuts and clinic closures, hard-won federal money and the property tax increase that county voters approved last fall have helped the department postpone, if not overcome, a projected multimillion-dollar deficit at least until the 2005-06 fiscal year.

For a department that is always in crisis, this passes for good news, and Garthwaite should take a minute to congratulate himself. A minute is all he can spare.

With the safety net in the poverty capital of the country holding -- for now -- the focus shifts to Sacramento. Think of L.A. County as a giant canary in a coal mine. With its huge population of people without medical insurance, it may have the most troubled health-care system in the state, but other counties are close behind.

A March report by Families USA, using U.S. Census Bureau data, put the number of Californians who lacked insurance for at least some period during 2001 and 2002 at 11 million. Many of the uninsured turn to hospital emergency rooms, which are required by law to treat everyone who needs help. As in Los Angeles County, hospital emergency rooms across the state get so backed up they’re forced to turn patients away, including those who are insured. Hospitals are losing so much money on unreimbursed care that some are threatening to close their ERs, which would make the problem worse.

State legislators have introduced at least five bills to reform the health system statewide. They range from a comprehensive overhaul to a minor tweak -- from replacing the existing private insurance system with a “single payer” government agency that would insure everyone in the state to simply increasing the number of low-income adults eligible for existing public programs.

Staking out the middle ground, state Senate President Pro Tem John Burton (D-San Francisco) seeks to strengthen employer-sponsored health insurance by requiring most businesses to either offer it or contribute to a statewide insurance fund.

Because of Burton’s clout and because of its labor backing, the bill, co-sponsored by Sen. Jackie Speier (D-Hillsborough), is seen as having a better chance than most at turning talk about health-care reform into action. That chance isn’t likely to come this year, given the state’s budget woes. Legislators will be challenged enough to protect the existing safety net from budget cuts.

But with five bills on the table and a growing consensus that the system needs fixing, there is a good chance that a healthy debate now could lead to reforms in the next year or two. Around the time, in fact, of L.A. County health system’s next threatened collapse, which makes for one loud ticking clock.