Sickness and Subways
One thing was made perfectly clear from the Shock Corridor reductions of Los Angeles County health care last week: providing health care for this regions needy is not a problem that can be handled, ultimately, on either the state or local level.
The Board of Supervisors last week tentatively voted to knock $57 million and 5,000 positions out of the foundering system that gives care to around 800,000 indigent people, the rough equivalent of the population of Detroit. What wasnt made clear was just how many of these people will now be out of the system. And what the fatal consequences to some of them could be.
There was strong protest from an audience of a thousand people. But what I did not hear were specific new solutions on how to solve this grievous lack of funding for health care in the largest local system in the nation. It was easier to call the board members names. But that didnt solve the basic problems of sudden revenue losses in a catastrophic budget year combined with long-term faulty Department of Health Services (DHS) management.
I didnt agree with all of the departments cutbacks. The worst mistake is that DHS didnt create $100 million of in savings by simply and immediately padlocking King-Drew Medical Center. This action would not only have taken out the worst hospital in the system. It would have set a terrific example among the surviving establishments that there would be dire consequences for having low-rated clinical departments and a decadeslong high ratio of patient deaths. Making K-D the survivor among the non-USC county hospitals cant help but send the opposite message at a time when maximum system performance is most needed.
The board had no real choices. It cant print its own money for health care. The money that is there comes almost entirely from the state and from Washington. Except, as we just saw, when it doesnt.
The countys own accountability in this matter is clear. Knowing that the 1995 federal fiscal support of its services was temporary, it promised Washington to restructure, to cut beds and increase clinical, outpatient care. (Federal and local health mandates, stuck in the Dr. Kildare era, gave fiscal preference to bed care, while most of the patient demand now is elsewhere.)
But DHS didnt deliver what it promised. More importantly, it didnt rebuild itself to focus on this key objective. Blame here accrues to both the boards bad oversight and the previous DHS director, Mark Finucane, a well-meaning in-house performance artist who seemed to assume that, when it came to changing the department, if you waved enough carrots, you could skip the stick.
So new DHS Director Thomas Garthwaite has been handed a huge backlog of overdue hard decisions. Mostly, apart from K-D, he seems to be making the right ones to save the system, if not all the patients. Well know more in eight months or so, when the hearings are finally over and the Mean Times DHS takes its final shape.
The major lesson here is the conceptual failure of state and local health care to meet the need for health care for that least articulate and most needy of constituencies, the working poor. Since most of DHSs indigent clients cant vote -- being either noncitizens or children or both -- whenever the budget gets tight, they are, like the steerage passengers down below on the Titanic, the first to go. But in last weeks hearings the patient population that takes the biggest hit from the cuts was direly unrepresented before the board.
For instance, on the one hand, the staff chief of Antelope Valleys local congressman, Buck McKeon (R-Valencia), spoke out against downsizing High Desert, which, according to Garthwaites reports, last year served only 50 local indigent patients.
Yet on the other hand, Supervisors Gloria Molina and Yvonne Brathwaite Burke, who represent the lions share of the countys hundreds of thousands of indigents, signed off on cuts in care to the poor.
Now here is a project for socially aware activists looking for an impossibly difficult but worthy task. How about building a Los Angeles County Patients Association, perhaps modeled on Justice for Janitors or the Bus Riders Union, that could represent what you might fairly call the victims of health-care injustice? And, perhaps, to file legal actions to protect their services in the same fashion that the Bus Riders Union sued to get more buses for the working poor? Kathy Ochoa, an official of Service Employees International Local 660, which represents many county health workers, last week proposed an organization that would combine the interests of county caregivers and recipients. Thats a start. But these parties interests are often by no means identical.
The final answer, however, is a national health-care system for everyone. The economy is a national issue, and so is the population that this economys missteps produces. Its 10 years since Bill Clinton had his national health-care proposal shot out from under him by the Republicans and the corporate health-care and pharmaceutical cartel. Has public -- and for that matter, private -- health care improved a lot since? Certainly not in this particular county.
The monuments to MTA subway corruption are conspicuous by their absence. They are stations -- lets say Laurel Canyon, Crenshaw Boulevard, Boyle Heights -- on the unbuilt lines that could be operating for tens of thousands of passengers today had not so many hundreds of millions instead been pissed away on rigged change orders, double billings, sweetheart contracts, payoffs, paybacks, kickbacks and other insider malfeasance that took place during the first 15 years of the projects existence.
This ongoing waste and pilferage of so much of the billions of dollars in federal funding discredited the entire project. Now this grand opportunity to make a more livable city may not recur in many of our lifetimes. Particularly since the passage of a voter initiative -- spurred by all that reported corruption -- ordering that no more heavy-rail transit be built in the county.
But when it comes to cleaning up a bad act, its better late than never. The MTA has been relatively free of major scandals over the past four years. The huge and suspect turnover in its upper ranks has ceased. When more recent scandals did arise, you increasingly heard about them first, not from the media, but from an MTA office -- specifically, the Office of the Inspector General. Who, for the past eight years, was a guy named Art Sinai.
I would love to be able to quote him. Hes a sharp guy with a street-smart Brooklyn attitude. And he sure likes to talk. Unfortunately, he doesnt talk on the record, even now that hes retiring. Those close to him say that he takes the most pride of accomplishment in getting former City Councilman Richard Alatorre under a sentence of home detention for much of that bad stuff he did as MTA chair and after -- particularly involving a notorious Eastside MTA contract.
There was a lot of whispering around City Hall after Alatorre pleaded out that Sinai should have snared a few of Alatorres buddies. But Sinai has a long list of other, less showy accomplishments, in turning the MTAs internal policies around and tightening up the ship to the point where, as he modestly puts it for the record, it is performing much better as an organization than it did in 1993.
Thats back when, in Sinais understated official words, internal controls throughout the system were weak or nonexistent, making the organization as a whole vulnerable to fraud, waste and abuse.
Art Sinai gets a lot of credit for that transition, and accordingly deserves our thanks.
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