Don’t Downsize Health Care Without a Full Debate : L.A. County: Consult providers and patients before enacting $600 million in cuts.

On Monday, the Los Angeles Board of Supervisors will hold a hearing to consider cutting up to $600 million from the county Department of Health Services. Such cuts, if implemented, will destroy the already tattered safety net, including the vital emergency rooms, trauma centers and acute-care hospitals that are outside the county system but that will be forced to close their doors if these cuts are enacted.

Such actions threaten not only the health of the 2.7 million people who depend on the county for their health care, but also the health of all 9.4 million people who live and work in Los Angeles. As a recent UCLA study confirms, one in three county residents has no health insurance, and we are all increasingly dependent on an interlinked system of county and private providers to protect our public health.

This crisis demands an open, collaborative dialogue between the county, community providers and the public. State law contemplates such an open process. The purpose of a “Beilenson hearing” is for the board to provide public notice of any proposed reduction in health services and for the public to provide testimony on the impact of those reductions.

Unfortunately, on Monday, this opportunity for input will be reduced to a meaningless formality. The public notice that has been posted states that the county health system--every hospital and every health center--may be closed or it may be left open. No specific information has been given as to the impact of particular proposed reductions or any concrete budget alternatives. How many more hours will a cardiac patient wait in the emergency room for care? How many more weeks will the woman with a lump in her breast wait for a biopsy? How many more children will wait in pain? How much greater will the risk be for widespread TB infection? What and where are health-care services available elsewhere, and, ultimately, what will be left in any downsized county health system? Without this basic information, no meaningful input or public testimony can be offered to the board.

A combination of problems with federal funding streams and eroding state and county financial support for health services has resulted in a $606-million shortfall in the county health budget. The board needs help to fill its budget gaps and in developing alternative routes by which the public can receive needed health care. But instead of dialogue, we will have only an administrative exercise.