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County Feels Symptoms of Health Crisis Relapse

A familiar scenario, the fear of system collapse is part of a long-standing problem with uninsured.

August 29, 2004|Jason Felch | Times Staff Writer

For the last 15 years, the crisis has been called a meltdown and a snowball, a doomsday scenario and a healthcare Chernobyl. It has been blamed on old people and more people; nursing shortages and earthquake retrofits; the uninsured, the indigents and the illegal immigrants.

Attempted solutions have included centralization and decentralization, "sin taxes," property taxes and federal bailouts. And somehow, the Los Angeles County health system has managed to survive.

But now public and private healthcare administrators are sounding the alarm yet again, warning that the system is on the brink of collapse, with growing deficits threatening to shut down hospitals.

Six emergency rooms have closed in the last 14 months. Hospital and healthcare officials predict a further 10% to 15% reduction in the county's emergency room capacity, with three large ERs at private hospitals thought to be at risk of closure.

For The Record
Los Angeles Times Wednesday September 01, 2004 Home Edition Main News Part A Page 2 National Desk 4 inches; 160 words Type of Material: Correction
Healthcare measures -- An article in the California section Sunday about the recurring crises of Los Angeles County's hospital system included incomplete references to supporters and opponents of two ballot measures. The article stated that Proposition 67, which would add a surcharge to telephone bills to fund emergency medical care, "is supported by hospitals." Several hospitals do support the measure, but the California Hospital Assn., the industry trade group, is neutral on it. The article also referred to the California Chamber of Commerce as one of the groups "backing Proposition 72," which is a referendum on a measure passed last year by the Legislature that would require some companies to provide health insurance to workers. Because the measure is a referendum on the underlying legislation, the chamber, which helped put it on the ballot and opposes the underlying measure, is advocating that voters cast a "no" vote. Hospital administrators and county officials are urging a "yes" vote on Proposition 72.

All of this is taking place as the number of Californians without health insurance continues to surge. Census figures released last week showed that the number increased by 200,000 from 2000 to 2003 and stands at 6.5 million, or 18.4%. The percentage is even greater in Los Angeles County, where more than one in four residents are now uninsured.

Since 1988, the number of emergency rooms in the county has dwindled from 97 to 79. Trauma centers have fallen from 16 to 13. Though some remaining hospitals have expanded their services to make up for those closures, the Los Angeles County population has grown by more than 1 million and the portion of uninsured residents has climbed from 20% to 27% during that period.

"Just because the sky didn't fall doesn't mean it wasn't dire," said E. Richard Brown, director of the UCLA Center for Health Policy Research, referring to the county's past healthcare crises. "The Chicken Little routine is helpful getting the bailout. The risk is we may do it too many times and people will stop believing us."

That day could come in November, when two ballot initiatives will present voters with tough choices between emergency services and taxes.

Hospital administrators and county officials are urging voters to defeat Proposition 72, which would repeal a senate bill passed last year that requires employers of 50 or more people to pay for 80% of workers' health insurance by 2007.

They say the bill could reduce the number of uninsured by 800,000. Those backing Proposition 72, including the California Chamber of Commerce, say the law is a $5.7-billion tax on employers and a $1.5-billion tax on workers that slows job growth.

The other initiative, Proposition 67, which is supported by hospitals and healthcare advocates in Los Angeles County, would add a 3% surcharge to phone bills in order to generate $150 million to pay for emergency room care, paramedic training and care, and community clinics.

Opponents of that measure, which include major telephone companies, say the tax is not justified because it would benefit large healthcare corporations without guaranteeing better service.

County health officials and many healthcare experts say defeat of Proposition 72 and approval of Proposition 67 would help stabilize the county healthcare system in the short term. But, they add, favorable action by voters would not address the issues underlying the county's healthcare crisis.

That, most experts agree, will only come with a national solution to the problem of the uninsured.

"It's going to take a consensus in America that healthcare is a right, not a privilege," said County Supervisor Zev Yaroslavsky, who has helped engineer bailouts over the last decade. "Until it gets personalized by someone everybody knows, it remains an intellectual exercise. If Elvis were alive today and didn't make it because he couldn't find a trauma center, then everyone would care."

In the meantime, what county health services director Dr. Thomas Garthwaite calls a "chronically semi-starved healthcare system" is likely to continue lurching from crisis to crisis, much as it has over the last decade and a half.

A Times headline in May 1988 could have just as well appeared last week: "Hospital Shuts Its Emergency Room: 'Ripple Effect' Feared."

In 1986, the federal government had required all hospitals that participate in Medicare to treat patients with emergencies regardless of their ability to pay. One in five people in the Los Angeles area were uninsured at the time, and hospitals said they could not afford to treat them.

Citing annual losses of $2 million, California Medical Center had announced plans to close its ER doors to ambulances. Neighboring downtown hospitals warned the move would send a wave of uninsured patients to their emergency rooms, causing them too to shut down.

"There are situations where people cry wolf," said then-state Health Services Director Dr. Kenneth Kizer at the time. "In this case, in Los Angeles, the wolf is at the door."

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