Haefele on Health Clinics

Los Angeles County is considering closing all but one of its public health clinics and outsourcing the services. The clinics serve more than 400,000 residents. The proposal comes from Health Services Director Dr. Bruce Chernof, who says his department is $195 million in the red. Dean of City Hall reporters Marc Haefele tells KPCC's Frank Stoltze there are many reasons for the financial crunch.

Marc Haefele: Well, I think we all know that the state's in a budget crisis, that George Bush's budget involves big cutbacks, and that even the county's own revenues, particularly those from real estate taxes in the post-subprime age, are suffering a big hit too. It's hard to see anyplace in the county's financial system where they aren't suffering losses, and this is one of the places that's showing up.

Frank Stoltze: And this is a system that deals with an incredible number of uninsured people.

Haefele: Mostly families. A lot of mothers with lots of children. I think any of us who, you know, had occasion to hang around these clinics have seen the familiar site of mothers getting off of buses with maybe four or five of their kids, getting them down for their immunizations or other treatment that's not available to them otherwise.

Stoltze: This is a system with a history of problems. Let's talk a little bit about the recent history.

Haefele: The recent history is, of course, the county's big catastrophe of losing King/Drew Hospital after many attempts were made to save it over too few years. I think we're getting down to the essence of the real problem with the system that has to do with the competence of its leadership.

Stoltze: Competence of board of supervisors, competence of the head of the county health department?

Haefele: Plenty of blame to spread around here, Frank. You have a systemic and endemic problem with the governance of this health system. The clinical care services are split among five different individuals of widely varying political persuasions, and widely varying areas of income. You can almost not figure out, if you sat down and tried, a formula to make adequate health care more difficult to deliver in a 10 million population political entity.

Stoltze: The county is promising that, in shifting some of these clinics' services to private providers, that there'll be no cut in services. But can that promise be kept?

Haefele: Maybe I'm missing something here, Frank, but I think that promise is preposterous! They're basically, the county health officials, are saying we're gonna switch these guys over to a venue which we have no responsibility for, strictly speaking, and we know they're gonna take good care of it. Basically, what they're basically doing is saying we'll wash our hands of it, but we assure you they're gonna get good care. And I think that's a contradiction in terms.

Stoltze: I wanted to ask you about some of the presidential proposals for universal or partial universal health care, at least on the Democratic side. Would that bring any relief to a county system like the one in Los Angeles?

Haefele: I'd go further than that, Frank. I'd say it may be the only thing that, at least in terms of the way it's now couched, that could save that system. We are looking at deficits in the hundreds of millions now. In four years, they forecast a $1.6 billion health care deficit in Los Angeles County. There's almost no way that health care can be maintained in any meaningful sense in the face of such a deficit, without something like a major revolution on the federal front.

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