A decisive vote in favor of a new property tax has recast the debate over Los Angeles County's foundering health-care system, probably saving two full-service public hospitals from closure -- at least for now.
Measure B, which passed with 73.2% of the vote, earned more support than any other initiative or candidate in the county. The measure, which is expected to generate $168 million annually, apparently resonated with voters who feared collapse of emergency and trauma-care services in the nation's second-largest health system.
"Yesterday we were talking about closing hospitals," Supervisor Zev Yaroslavsky said at a news conference Wednesday morning. "Today, we can talk about how to keep them open."
Measure B, however, doesn't solve all the county's budget woes: The county Department of Health Services still faces a deficit of $332 million to $582 million in three years.
The approval also leaves county supervisors indebted to a key labor union, which donated about three-quarters of the $2 million spent to promote the proposition, making it even tougher for supervisors to cut jobs.
Moreover, the federal government made it clear Wednesday that it would not step in to fill the budget hole.
"I have no plans to be a knight in shining armor," said Tom Scully, administrator of the U.S. Centers for Medicare & Medicaid Services, who toured some of the county's public hospitals Wednesday, including Harbor-UCLA Medical Center near Torrance. "I don't expect to be a savior or hero."
Scully commended voters for approving Measure B but made it clear that he still opposed the county's request for a $1.4-billion bailout. He also demanded that the county make its system more efficient. The county health department serves about 800,000 people a year, most of them poor patients without insurance.
We need to "come up with a responsible fix that doesn't waste taxpayers' money," Scully said.
The only agreement to come out of the supervisors' meeting with Scully at Harbor-UCLA was to continue private negotiations.
County health officials said their negotiating position was strengthened by county voters' willingness to directly tax their property -- the first such decision since passage of tax-slashing Proposition 13 in 1978. Yaroslavsky said the approval was all the more remarkable because the late Howard Jarvis, one of the promoters of Proposition 13, based his movement in Los Angeles.
The county's dire financial straits became apparent in recent months when officials shut 11 community clinics, opted to convert High Desert Hospital in Lancaster to an outpatient facility and decided to shut the Rancho Los Amigos rehabilitation center in Downey.
Faced with the prospect of closing two of the county's four full-service public hospitals -- Harbor-UCLA and Olive View-UCLA Medical Center in Sylmar -- supervisors voted 3 to 2 in July to put Measure B on the ballot.
The initiative imposes a tax of 3 cents per square foot on residential and commercial property, or about $42 a year for a 1,400-square-foot home.
Proceeds from Measure B must be used solely for emergency rooms, trauma centers and bioterrorism preparedness.
Instead of running an organized campaign, opponents gambled that it was unlikely the measure would pass with the two-thirds vote necessary to raise property taxes.
Even supervisors who supported the measure didn't think they could reach this goal. But backers say the measure's prospects improved two weeks ago when a union-backed coalition began running a television ad that dramatized people's fears.
The ad showed a sweating paramedic in an ambulance making an urgent radio call about the injured child he's treating -- only to be told that the nearest hospital is closed to trauma patients. A dispatcher directs him to another hospital.
"It's too far!" the paramedic says, as the boy's distraught mother looks on.
"It's very emotional," said Robert Blendon, a health-policy professor at Harvard University. "People can understand that."
Supervisor Don Knabe, who initially opposed the ballot measure but switched sides days before the election, said he was "really surprised by the depth and scope of the victory." He said voters understood that they may be "one heart attack, one car wreck, one of God's winks" away from needing the trauma network, which has dwindled from 22 hospitals in 1985 to 13.
County supervisors heaped much of the credit for the victory on the Service Employees International Union, whose local 660 represents 19,000 county medical workers, among them nurses and laboratory technicians.
But county supervisors may have boxed themselves into a corner. The most costly element of the health-care system is labor, but the supervisors' political alliance with the union makes deep job cuts unlikely.
Union leaders want the county to revoke its decision to close High Desert Hospital and Rancho Los Amigos. Both public hospitals do not have ERs.