Health System in Crisis

Revelations about the deterioration of care in the public hospitals of Los Angeles County and the announcement of yet another trauma center closing have underscored the urgency of state budget negotiations now under way in Sacramento. The crisis in indigent health care is not limited to Los Angeles County. It is a statewide problem. And remedies depend on state funding.

More than 40 doctors and nurses in Los Angeles County hospitals prepared the new report on health care, offering evidence of “preventable” patient deaths and signs that the system is getting worse. Their objective is to illuminate next week’s budget hearing before the county Board of Supervisors. But their report is of particular consequence to this week’s budget bargaining in Sacramento, for state funding must be the main source if the deterioration is to be arrested.

Next week’s hearing will focus on the $55.7 million in cuts proposed for the county Department of Health Services in anticipation of reductions in state funding. The county’s budget, like that of other major counties, including Orange and San Francisco, has been hard hit by the delay in appropriating current revenues from the new tobacco tax. Planning for next year has been made uncertain by challenges to state health funding posed both by the education initiative, Proposition 98, and by moves to divert tobacco tax funds from expansion of health services, as intended by Proposition 99.

The desperate state of the health care system is fresh evidence of the need for fundamental reforms that will assure basic services to all persons. More than 5 million Californians are without health insurance even though most of them are workers or the dependents of workers. While permanent remedies are sought, however, increased funding must be fed into the existing system to patch the safety net for both basic care and to preserve the trauma network. County supervisors have increases in revenues with which they can address some of those problems. But they will require substantial increases in help from Sacramento if they are to make real progress in reversing the deterioration.