Health Care in California Is Sick : We’re Among the Worst States on Several Fronts

California’s health-care system is failing badly. The problems are easy to spot. First is the large and growing number of medically uninsured people. Recently released figures from the Employee Benefit Research Institute in Washington show that California has the seventh-highest rate of uninsured in the nation: 21.4% of Californians under age 65 were uninsured in 1985; the national average is 17.4%.

But we don’t need surveys to tell us about the uninsured. Just ask around. Ask almost anyone who is self-employed, or who works for a fast-food chain or a retail clothing shop. Ask the newly unemployed, the part-time or minimum-wage worker, or those who labor in our restaurants, on our farms and in many of our factories.

There also is a lack of commitment to the health of poor mothers and children. California now ranks 9th among all states in the effort to reduce infant mortality, 31st in providing early prenatal care and 15th in low-birthweight babies. And the gap between white and black infant-mortality rates remains as shocking as ever. A 1987 Children’s Defense Fund report found that the 1984 death rate for white babies was 9.2 per thousand births in Los Angeles and 8.8 per thousand in San Diego; for black babies the 1984 rate was 19.9 per thousand in Los Angeles and 18.1 per thousand in San Diego. California’s food program for poor pregnant women and their children under age 5 serves only 31% of those eligible.

Then there is the financial crisis facing Medi-Cal--a program that provides health care to about 3 million mothers and children, senior citizens, the blind and disabled poor. Gov. George Deukmejian is proposing sweeping cuts in the program, which by all accounts already is underfunded. In a study of Medicaid expenditures in 10 states between 1981 and 1984, California was the only one to show a negative growth rate. The other states showed increases in Medicaid funding that ranged from 15% to nearly 60%.

Finally, the state’s public hospital system is being destroyed. Since 1965, 34 public hospitals have closed. There now are only 31 such hospitals still open, which leaves more than half the counties in the state without public hospitals. And those that are left are underfunded, understaffed, underequipped and overcrowded. Los Angeles County’s health-care system is facing a $106-million shortfall at a time when the county’s hospitals operate at more than 100% occupancy. California’s public hospitals are the major providers of care to the uninsured poor. Although they make up only 5% of the state’s hospitals, they provide 45% of the state’s charity care.

There are no solutions in sight for the problems afflicting our health-care system. Neither the private nor the public sector is willing to spend money to find them. Last year the California Chamber of Commerce studied the problem of the uninsured and concluded that it “was a financing problem for state and local governments to address.” Thus, although it was a problem, it was not the problem of business.

Counties continue to look to the state for answers even as the governor slashes the state’s health-care budget. The Legislature points to the Gann limit, which restricts state spending, as the reason nothing can be done about health care, and legislators are afraid to even suggest raising taxes. So the Legislature looks instead to Washington for help that the Reagan Administration will not give. Our private hospitals, physicians and insurance industry maintain that care for the poor is not their responsibility. These groups lobby hard against any proposal to share in the financial burden of an improved health-care system.

The bottom line, however, is that it is the complacency of most of our citizens that leaves our health-care system in such poor health. We should not fool ourselves. Any improvement in the state’s system of care for the poor and elderly would cost money. But it would be money well spent.

In 1932 the Committee on the Costs of Medical Care issued perhaps the most famous report on health-care delivery in U.S. history. It said: “Many persons do not receive service which is adequate either in quantity or quality, and the costs of service are inequitably distributed. The result is a tremendous amount of preventable physical pain and mental anguish, needless deaths, economic inefficiency and social waste . . . . The United States has the economic resources, the organizing ability and the technical experience to solve this problem.”

That was 45 years ago. We can wait no longer for the federal government to act.

It is a cruel society that does not care for its poor and sick. California must take the lead. Surely this state and its people have the “economic resources, the organizing ability and the technical experience” to address one of our most pressing needs--the health and well being of our poor. The question is: Do we have the will?