In the face of marches and protests by patients and health workers, the Los Angeles County Board of Supervisors last week stuck with its plan to close 11 primary-care clinics and four school-based clinics. Are the supervisors grandstanding? Or are they just trying to keep the fraying health-care system from going under and taking the county with it? Both.
There is certainly an element of brinkmanship in the board's threat of even more dire cuts in October unless the federal government helps assuage a looming $800-million deficit. But the board has to somehow win the attention of Gov. Gray Davis and the Bush administration. Both seem bent on ignoring the problem of uninsured workers, even when the county with the largest uninsured population in the nation is nearing a meltdown.
State health officials say they need to study the county's plan before Davis can pitch it to the federal government. Fair enough. But they shouldn't use their questions as a delaying tactic to help the governor dodge responsibility. If they don't like the county's plan, they should offer an alternative.
Today's crisis is partly the fault of county bureaucracies and other inefficiencies. Streamlining should have begun a decade ago. But ultimately the problem is, as Supervisor Gloria Molina put it, "We have too many working poor and no one willing to pick up the tab."
In 1995 and 2000, the Clinton administration bailed out the county by waiving federal rules that reimbursed hospitals for caring for uninsured people, but not outpatient clinics. In theory, pushing the county to offer more outpatient care should save money by keeping patients out of hospitals. In turn, the county can then use the savings to run clinics as the waiver is phased out over the next three years.
The projected savings have not materialized. Clinics and hospitals alike are overwhelmed by growing numbers of uninsured patients.
With its large immigrant population and high percentage of jobs without medical coverage, Los Angeles County may be the epicenter of the uninsured crisis, but it's not alone. UC Irvine Medical Center just announced cutbacks, saying it could no longer shoulder caring for Orange County's uninsured.
This is not solely a county problem. And it won't be solved until the state and federal governments quit backing away from a problem that is theirs too.