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Mean and Cheap 

The state drops the ball on health care for health workers

Wednesday, Feb 9 2000
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When last we wrote of local home health-care workers, there was hope in the air. As you may recall, the Los Angeles County Board of Supervisors asked the state for some health-care benefits for primary health-care givers. Those workers -- 73,000 of whom have registered with the county -- come into your home when you can’t take care of yourself and take care of you. They help many thousands of seniors, people with disabilities, and people of all ages who simply need care during recovery from severe accidents and illness. They do difficult work; they get paid around $6 an hour to feed, clean, medicate and otherwise assist people in their homes. ”The work they do is unremunerative and burdensome,“ said Supervisor Zev Yaroslavsky last week. And in its difficulty and quiet importance, there‘s something saintly about their task.

So why is the state suddenly trying to offload its share of the health-care burden on the counties? Late last year, this column reported that the county was requesting -- via a motion by all the supervisors -- that the state cover some or all of the costs of a health-care benefits program for registered county health-care workers. Many observed that it was not a little ironic that the people who provide basic care for so many of us had no health plans of their own. Assemblyman Gil Cedillo initiated legislation toward that purpose. Supervisor Gloria Molina, who introduced the December Board of Supervisors initiative, observed that what the care workers needed most was their own medical program -- even more than they needed a raise in their minimum $6.25-an-hour pay.

She’s a Democrat. So is the governor. So is most of the Legislature, for what that‘s worth. You usually write about things like this, and go on to other business, because there doesn’t seem to be much standing in the way of their accomplishment. But I should have known better.

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The first tip-off that things weren‘t on course was in Governor Gray Davis’ initial budget message, which didn‘t mention health care for care providers, but instead mentioned higher wages for health-care providers. While not a bad thing, this indicated that the governor and the county supervisors were not on the same page as to what the care workers needed.

Then came more detail: The state also wants the perpetually strapped county to pay for the promised care workers’ pay increase. And you had to stop and think: Just how generous can our governor get? ”This is in the face of a $3 billion state-budget surplus,“ objected Miguel Santana, Molina‘s deputy.

”This was supposed to be a partnership,“ noted Yaroslavsky, ”with the state picking up costs.“ Currently, the state picks up 80 percent of those health-care-worker costs, while the individual counties pay 20 percent.

But the crucial datum, said Yaroslavsky, is that the state saves money even under the current system whereby it pays the lion’s share of care costs. That‘s because when disabled people can’t get home care, they have to be moved to nursing homes. And for this care upgrade the state pays more.

All of which makes one wonder just what priority health care has in the Gray Davis administration. Certainly, it stood in the shadow of education in Davis‘ State of the State message. It took the governor many months to appoint his current state health director, and when he did so, he ended up eschewing several nationally prominent choices in favor of Diana Bonta, whose previous career apex had been as health chief for the city of Long Beach.

Insiders suggest that the state’s health division badly needs both new goals and new, strong leadership. There are many reasons for this, including the growing number of people dependent on public health care in urban and poor rural California communities. But we also ought not to forget that, for 16 years, the state health department was a Republican satrapy, dominated by small town--conservative AMA types. If it‘s going to express the higher ideals of Gray Davis’ party, this bureaucracy needs lots of winnowing out.

Otherwise, we‘re going to see lots more brilliant ideas. Like the one about picking the counties’ pockets to boost the wages of the home-care workers who save money for the state.

Billie, We Hardly

Knew Ye

The semiofficial reason, of course, why Mayor Dick Riordan recently decided to delete some prominent city managers is that, while he‘s been mulling their ouster for some time, now the new charter will soon empower him to do so more easily. The reported targets include Cultural Affairs General Manager Adolfo Nodal, General Services chief Randall Bacon and freshman City Administrative Officer Bill Fujioka.

Riordan may have long been stalking the former pair, both of them Tom Bradley appointees. Nodal has seemed quite competent in what is an extremely controversy-prone job. But Bacon’s reign over the omnipotent department that supplies the city with everything from gold-leaf names on doors to toilet paper has long been problematic. City Hall scuttlebutt holds that Bacon and Nodal are under such heat (Bacon has announced plans to resign) due to the mayor‘s disappointment with the Los Angeles millennial festivities, in which their departments were implicated. Er, involved. Well, at least you can’t say this problem is likely to come up again soon.

But how about the hapless Fujioka, who had (so far as I know) nothing to do with the 2000 flop? And while we‘re at it, what is a city administrative officer anyway? Well, the CAO used to do the budget for the mayor, which was a big deal indeed. Hard to recall though it may be, under Bradley the CAO seemed as powerful as the mayor; his staff reports could then make or break an ordinance. Back then, the slender, double-breasted, owlishly eyeglassed figure of CAO Keith Comrie observed the City Council from the sidelines the way Cardinal Richelieu used to scope out Louis XIV’s court. Not even independent departments -- Airports, Ports, Water and Power -- were immune to his probings.

Comrie‘s star sank under Riordan, who was certain there was nothing he didn’t already know about allocating; Riordan assembled his own budget squad and let the lights go out in the vast CAO quarters. The city doesn‘t seem much worse for the budget switch. But, minus the critical work the CAO’s analysts used to perform, it‘s much harder for reporters and other interested parties to track city operations. Which probably doesn’t much bother the mayor.

Comrie kept himself busy on the new charter until it passed. After he departed last summer in his new, retirement Porsche, an alleged nationwide search for his successor detected Fujioka in L.A.‘s own Personnel Department.

By then, there was little left for the new CAO to do except follow Riordan’s orders to work toward changing the CAO‘s operation into the new charter’s so-called Office of Administrative and Research Services, on whose exact purpose few agree. Now that the mayor supposedly wants him out, some say it‘s because Fujioka dared to voice his own views on how best to restructure financial operations.

But Riordan can’t easily get rid of him, since the council can still reverse mayoral firings by eight votes -- which it probably would in this case. In fact, this council owes the mayor so few favors that it might retain Fujioka even after the July start-up of the new charter provisions (which require 10 council votes to save a manager from mayoral firing). This indeed would be a perfect opportunity for the council to prove that, with a greater sense of unity, it can still kick the mayor‘s butt. Even under the new rules -- which various councilpeople loudly predicted would make Riordan omnipotent.

Meanwhile, as the latest City Watch downtown newsletter puts it, ”It will be a tense five months for Mr. Fujioka.“

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