PERSPECTIVE ON HEALTH CARE : Can We Deny Aid to the Poor? : Imagine waiting 16 months to see a doctor. That’s what state cuts have done, to the peril of everyone’s well-being.

Through most of America’s recent history, the poor got decent health care. Throughout the Great Depression and the prosperity of the 1950s and ‘60s, the poor could at least go to a county hospital and get needed health care free. There were no frills, but the medical standards were the same as those prevailing in the larger community.

We are now turning away from that legacy in Los Angeles.

State appropriations to Los Angeles County in the June budget fell $184 million short of meeting current minimal needs. Insiders in Sacramento believe that the state revenue situation is, in fact, worse, and that the true extent of the problem will be revealed only after the November election. Making things even worse would be passage of Proposition 187, the “save our state” anti-immigration initiative, which could make California ineligible for $15 billion annually in federal funds.

The budget problem would be difficult enough if we had consensus that we must provide care for the poor. That notion, which goes back to the church-run hospitals of medieval Europe, is under increasing attack. There is a growing political faction unwilling to pay for any services for the poor, including health care.

For years it has been said that the State Assn. of Counties favored repeal of Welfare and Institution Code 17000, the key provision that obligates counties to provide care for the poor. In the 1992-93 budget debate, Gov. Pete Wilson openly sought repeal of WIC 17000, offering nothing to replace it. When that effort failed, he accepted amendments that weaken the standard of medical care to which the counties can be held--the poor may now be legally offered a lower standard of care than the rest of us. No lower limit is set.

This fundamental change has gone virtually unnoticed and unchallenged, yet it represents a trend, a change in public policy that, though never articulated or put to a vote, profoundly affects our lives, our community and our future.

Since 1980, the net county contribution to the Los Angeles County Department of Health Services budget has declined from 19.3% to 6.25%, while state and federal shares have grown; meantime, the population has increased from 7.4 million to 8.97 million and the percentage of uninsured--those who really need county hospitals and clinics--has increased to 33%. Simultaneously, Medi-Cal, the federal/state health-care program for the poor, has interpreted its eligibility rules to make the majority of the poor ineligible. Today in Los Angeles County, there are 1.5 million people receiving Medi-Cal assistance, while there are 2.6 million uninsured poor who are ineligible.

County hospitals no longer meet community standards. The current wait for a neurology clinic appointment at Martin Luther King Jr. Hospital is 16 months. No private neurologist in the country would allow patients to wait that long. A person having symptoms indicating a stroke or perhaps a tumor must be seen promptly.

A woman at a county clinic was recently advised, after an abnormal cytology, to have her uterus removed, because getting a biopsy would take too long. Such further diagnostic study might allow her to keep her uterus and her ability to bear children.

We know that patients with painful but not life-threatening conditions wait as long as 16 hours to be seen at county hospitals. One of those patients last year shot three physicians at L.A. County-USC Medical Center. The county has put in security measures, but it has not reduced the inhumane delays.

Some public-health activities--assurance of clean water, sanitation, immunizations, disease surveillance--have a greater impact on life span and on quality of life than do individual visits to the doctor, but the number of district health officers in Los Angeles County has dropped from 25 to 16 in the past year. This has happened at a time when the re-emergence of tuberculosis, the spread of AIDS, the incidence of drug-resistant bacteria and newly mutating viruses call for a reinforcement of our public-health systems. Public-health doctors will have even tougher jobs if Proposition 187 passes, with a large population of illegal residents going into hiding.

As to whether we should provide health care for the poor, beyond the humanitarian aspects there are valid, practical reasons for doing so.

Not providing care could spark social unrest. If that seems far-fetched, consider the Los Angeles riots of April and May, 1992. Consider the possibility of people you care about dying needlessly, the anger and outrage you’d feel if they perished only because they were poor. Consider that we’ve quietly changed public policy without warning the poor, who may still think they will receive basic care if they need it. Under these circumstances, social disorder is not unlikely. We built Martin Luther King Jr. Hospital in response to the issues raised by the Watts riots of 1965, but we run it in a way that doesn’t really serve its intended purpose.

Abandoning basic health services for the poor is a questionable policy precedent. No other major industrialized economy has dared to remove health-care benefits from a previously covered lower class. The health, economic, political and social consequences are unpredictable.

Even if we could withdraw services without costs exceeding the expected savings, the medical consequences could not be isolated to affect only the poor. When tuberculosis gets out of control, it threatens all. As trauma services are lost, they are lost to all, even those who can pay. Moreover, if good services are available in one part of town and not in another, the poor will be likely to go where the services are available. Are we prepared to deny care at the point of service, one on one?

Beyond these mundane reasons, there are more noble ones for providing care to the poor. Our religious and social values do not tolerate needless suffering and death. We value people regardless of their social station, age, race or gender. “All men are created equal” and endowed by their Creator with certain inalienable rights, including life. In a sense, providing basic health care to all is part of our democracy. It can’t be separated from our political and social equality or equality of opportunity.

What are we to do? If we can’t withdraw basic medical services to the poor without violating cherished principles and tearing our society apart, we must then resolve to provide them. Recognizing and accepting that proposition is critical. Short of accepting moral decline, economic disadvantage, social and political upheaval, it is the only course open to us.

At base, this is a political decision. We must unequivocally reaffirm our support for basic medical care for all. Welfare and Institution Code 17000, or something like it, must be preserved--we must embolden our leaders to ensure that everyone gets needed care. Our county health-care system, which needs a careful, critical reappraisal, must be adequately funded. Medi-Cal, it if is to exist at all, should cover more than half of the poor. Most important, we must insist on meaningful national health-care reform, now. With 37 million uninsured nationally, 5 million to 6 million statewide and 2.6 million locally, something must be done. We can’t waffle any longer, and we can’t let our political representatives waffle on our behalf.