The message that trauma care is expensive medicine that Los Angeles cannot afford to lose seems to have gotten lost in the Legislature's eagerness to use Proposition 99 (tobacco tax) revenues to resolve the long-term issues of uncompensated care, universal health insurance, workers compensation and the skyrocketing costs of medical care.
While negotiations on these global issues have been slowly making progress in Sacramento, trauma centers in the South have continued to close their doors.
Since 1983, the combination of state and federal cutbacks, private cost-containment efforts and the prohibitive costs of medical care have turned the state's medical payment system from "fee-for-service" to "service for free." The major consequence has been fewer and fewer providers willing to care for a growing number of patients who are unable to pay their bills.
While there is still hope for legislative action that will revamp the entire public health-care delivery system in California, what is currently being proposed may be too little and too late to save our trauma centers.
All 10 of the trauma centers that have closed in Los Angeles were in non-county hospitals. Trauma centers are by their very definition expensive to operate, and for private hospitals that receive no public funding, the cost has now become prohibitive.
The Legislature staff proposal currently before the Prop. 99 conference committee will not guarantee the survival of our remaining trauma care network.
Among other things, the proposal would spend nearly $83 million on county capital outlay projects, and $338 million to cover the costs of uncompensated care. Only $30 million is specifically earmarked for private hospitals, and no special consideration is given to hospitals operating designated trauma units.
I do not know if the people of California voted "Yes" on Prop. 99 because county hospitals needed new offices and X-ray machines. I do know that they voted "Yes" because trauma centers and emergency rooms were being forced to close.
Even more egregious is the setting aside of over $30 million for a rainy day. For the victims of drunk drivers, gang shoot-outs and heart attacks in Los Angeles, it's not raining, it's pouring.
Assembly Speaker pro Tempore