The disintegration of the Los Angeles County regional trauma network is one of the best things ever to happen to health care in Southern California.
The trauma network assured everyone in the county--residents, visitors, people just passing through--that no matter where an accident might befall them, they would have rapid evacuation to a hospital where appropriate care was available. The network collapsed because some key trauma hospitals were caring for large numbers of uninsured patients for whom government reimbursement was inadequate. With the program's demise, everyone--not just the poor, who usually suffer when programs are cut--faces the possibility of receiving inadequate care in an emergency because they may not have rapid access to a hospital with specialized trauma care.
Now the denizens of well-heeled districts will have to bear some of the consequences of government spending cuts that they support. Maybe, just maybe, this event will awaken the citizenry to the frustrations that the poor face in their every effort to obtain medical care.
America stands out among Western industrialized nations in having one of the greatest disparities in income between rich and poor as well as the least-developed social services. The ability of haves to insulate themselves from realities that dominate the lives of have-nots contributes mightily to this state of affairs. People who send their children to private schools don't know, and don't want to know, about the desperate need for resources of inner-city schools. They don't care about the choice of a location for a state prison because, wherever it is, it won't be near their homes. They'll hardly notice the state tax rebate, which could have had an effect on programs to reduce unnecessary death and disability among the poor. The poor and their problems don't exist. America stands tall, and ignores the debris at its feet.
If America survives this era, the fundamental inhumaneness of this society will be seen in the record of medical care for the poor among us.
Policy analysts Geraldine Dalleck and E. Richard Brown recently published a report on the quality of medical care available to the poor in Los Angeles, showing not only that it is abominable (we knew that) but also that it is getting worse. Ambulatory care is pervasively inadequate. Patients wait as long as two months for biopsies of tumors. Those with seizure disorders or heart problems that merit follow-up visits within two weeks are seen at intervals of three months or longer. The wait for an initial prenatal visit was four weeks or more at 18 of 21 county health centers surveyed, and more than eight weeks at five centers. Sixteen percent of women giving birth at county hospitals received prenatal care only in the third trimester or not at all. County hospitals account for 19% of all births in the county, and that share is increasing rapidly, but the number of obstetrical beds is inadequate. It is hardly surprising, then, that County-USC and King-Drew hospitals have the worst perinatal death records in California, according to the report.
Los Angeles is not unique in this respect. Howard Freeman of UCLA and others, reporting results from a large 1986 national survey, showed that access to care has deteriorated seriously for the poor throughout America since 1982.
Publicly funded health-care programs for the poor have failed in important respects precisely because the non-poor have no stake in them. Medi-Cal and other states' Medicaid programs for the poor are sick jokes in which most physicians will not participate because of restrictions and underfunding. Medicare is supposed to take care of the elderly, but those of them who are poor or near-poor spend 25% of their marginal incomes on medical care. This sad state of affairs will persist if President Reagan vetoes pending legislation to expand Medicare.
Programs that are only for the poor will never work, because most taxpayers object to spending what it takes to make them work. It is in this context that the loss of the trauma network is a blessing. The trauma network was for everyone. If cutbacks and underfunding were limited to public services used exclusively by the disadvantaged, an important lesson would be lost.
The most rational and humane solution to the problem of access to medical care would be to establish a universal health-insurance program that maintained fee-for-service private practice.
Canada's experience with a national health-insurance program is instructive, despite the differences between our two countries. The Canadians' program generally works quite well, precisely because it puts everyone in the same boat and the electorate would not tolerate inadequate funding.
Alas, it is unfashionable in this country to advocate anything, however rational, that could be construed as "tax and tax, spend and spend." Perhaps further assaults on medical programs that the middle and upper classes value, like the trauma network, will eventually change that.
In the meantime, fasten your seat belts and drive carefully.