Health Care Issues in Los Angeles
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3. Letter From the Governor of California
Ensuring basic health services to citizens is a recognized obligation of all civilized societies. Certainly every American has the right to quality health care. And yet it is a right increasingly denied. Los Angeles County in many ways illustrates a nationally flawed health care system. In reality it is even worse shape than other jurisdictions around the country. Our basic health care safety net is badly frayed and nearing the breaking point.
Regulating medical care quality and delivery systems is a widely accepted function of government. This means setting laws and standardizing correct practices for medical care providers and monitoring doctors and hospitals to ensure compliance.
So there is a right to health care and a regulatory system in place to enforce standards of quality care. What is missing is the financial infrastructure to guarantee that right. Standards of care are relevant only to the declining population that can afford care in the first place.
For over 100 years, California state law has designated the counties as the responsible entities to monitor and deliver care to local residents. With nearly 90 individual cities and a population of more than 10 million people, Los Angeles County, were it a country, would be the 14th largest in the world. 27% of all Californians live here.
25% of the residents of Los Angeles County, 2.5 million people, are uninsured. A significant number are under-insured medically. Both numbers are growing. Add to that the unknown number of undocumented residents without insurance and the number becomes staggering.
A significant portion of the uninsured is homeless, intermittently homeless or living at risk of homelessness. This number is estimated to be as high as 140,000 in Los Angeles County, with 85,000 out on the streets on any given night. Some of the homeless population is transient. About a half to three-quarters of these people are eligible
for funding for housing and health care that they do not receive.
Eleven hospitals in the County, including King-Harbor, have closed in the last five years. Five emergency rooms closed during the same period. These closures add stress to those that remain open. By virtue of reduced MediCal and MediCare reimbursements in the face of rising costs, increasing numbers of medical providers are refusing to accept patients who are most in need. The exodus of providers adds to the burden of those providers who remain in the system.
To remain financially viable, local hospitals try to pass un-reimbursed costs back onto insured patients in the form of higher fees, which increases the cost of care and puts once-affordable health care out of the reach of an ever-increasing number of people.
In the past 25 years, even as wages doubled, health care costs increased five-fold. Each year, the cost of health care continues to outpace cost-of-living adjustments in compensation. Insurance companies are increasing co-payments and deductibles to try to meet rising costs.
Even much of the insured population exhausts the limits of its coverage and is forced to rely on County services. People easily exhaust their financial resources during acute illness even though technically they are “insured.” And where entire families may have once been covered, spouses and children may now be excluded from health care benefits to workers because of the financial burden of dependent coverage.
Fundamentally, there is not enough local, state and federal money available to sustain health care facilities and health care services in Los Angeles County and other major jurisdictions around the country. As the availability of care is increasingly limited, the demand for care is rising, even among the insured population.
The health care safety net is frayed and in danger of collapse in Los Angeles County and elsewhere. More than anything else, what we need is a system of health care that is universal and national, a system that will provide through equitable patient funding the resources needed to keep hospitals open and health care professionals willing and able to provide care.
Universal health care cannot be obtained by placing the primary burden on employers, as has been proposed in the state legislature. It cannot be implemented locally, as has been proposed in San Francisco. And it cannot be provided by individual states, as the Massachusetts experiment is demonstrating. And we cannot mandate the purchase of health insurance at the risk of a fine for people who simply cannot either the insurance or the fine.
Universal health care is the foremost domestic challenge this nation faces and the only option available and desperately needed to prevent collapse of the health care network in the County and ultimately in the country.
The County and MLK
Last year’s closure of the King-Harbor as a full-service hospital was not merely a symbolic defeat for the community. It was a stunning blow to the health care needs of the most medically under-served population in Los Angeles County.
While urgent care is still provided, the closure was a falling domino that dispersed patients into emergency rooms at already overcrowded hospitals elsewhere in the region. About 250 ambulance rides a month take patients from King to County emergency rooms elsewhere.
King-Harbor must be reopened as a full-service hospital at the earliest possible date under the management of a competent and accountable partner. I am not comfortable with a quickie band-aid-
type fix, however, and I fear that may happen if we rush too quickly to accept a new management that would try to do too much too soon.
I believe in reopening King-Harbor in stages. Our first priority should be to restore it as a quality community hospital. As that is accomplished, we can then add specialty services like trauma care, specialized surgeries and specialized critical care functions. We need to build a center that is solid and stands on its own merits for the long haul.
I think the collaboration of a teaching institution, preferably a UC system school, is important, particularly in restoring needed training programs and the restoration of teaching hospital status.
Who oversees the work of any management partner is critical. While maintaining oversight and control of County funding, the Board of Supervisors cannot and should not be the primary interface. The County needs an independent, expert and accountable structure to do this.
An alternative would be a County Health Authority dominated by health care and health management professionals sufficiently insulated from political vagaries to provide firm and dispassionate oversight, completely transparent in what it does and the way it does it. Proposals to form such an authority have been on the table for a decade and have not advanced, but that’s no reason to discard the idea.
Also, new ideas such as replacing our current dysfunctional healthcare bureaucracy with an elected L.A. County Surgeon General should be explored.
The ultimate goal should be to restructure the health care management in the County by the creation an independent and accountable governance system.
Whatever we do, we must acknowledge that the current system does not work. MLK was a victim of that system and the entire health care delivery system of the County has suffered as a result.
Policy Positions on Health Care
As Supervisor, I will work to implement the following health care policies and programs:
- Universal health insurance for all Americans.
- Reopen King-Harbor as a full-service community hospital. Develop and implement a plan to restore professional medical training programs and teaching hospital status.
- Require formal monthly reports to the public on progress to reopen King-Harbor and progress as it reopens.
Restructure health care management in the County by the creation of an independent and accountable governance system.
- Establish a central authority to handle complaints and problems in the health care system.
- Secure an independent financial audit of funds for County health care expenditures since the beginning of 2006
- Secure an independent performance report of all County health care facilities and programs to establish where we are and where we plan to be in 5 years. Recommendations should including infrastructure requirements and costs for them.
- Develop and implement a plan to work with local hospitals on a unified front that does not sweep problems under 'each others' rugs,' as health professionals and administrators now claim.
- Strenuously oppose additional cuts to the MediCare and MediCal programs.
- Reduce costs by investing in Information Technology to coordinate medical care faster and more efficiently and with fewer medical errors
Put the focus on healthy lifestyle choices for young people by banning soda and junk food from local schools to prevent obesity and diabetes, as LAUSD has already done.
- Secure health care coverage for County employees through an open Request for Proposals process. Incredibly, an RFP for such services has not been issued in several years, denying the County cost savings that could result from an open process.
- Deny County contributions to health care policies for employees who make unhealthy lifestyle choices. While still in the formative stages, I am considering a proposal that would require employees who smoke, for example, to pay the full cost of their health care coverage. While they would receive the benefit of the discounted pool rate for coverage, they would not receive the 90% contribution the Count currently provides. I view this proposal as a public health measure and as a way to assure that taxpayers do not subsidize knowingly unhealthy behavior.
