U.S. Must Protect Endangered Public Hospitals

LOS ANGELES--The U.S. Centers for Medicare and Medicaid Services recently announced that it would pull the plug on funding Martin Luther King Jr./Drew Medical Center in Los Angeles. The agency accused King of poor management, and providing poor patient care and service. King, born out of the ashes of the Watts riots in 1965, for decades has been one of the nation's flagship hospitals for public health care. The hospital, like all public hospitals in America, is the hospital of only resort for thousands of health-challenged poor, needy, uninsured mostly black and Latino patients.

King is a tragic example of a flawed and failing public hospital. But its problems are the same ones tormenting public hospitals everywhere. In recent years, more public hospitals have been shuttered, and those that stay in business have had to shrink the number of patients they serve. In the past 30 years, more than one-third of all public hospital beds have been lost. There has also been a sharp drop in the number of public hospitals in the suburbs. But the suburban tag is misleading. The public hospitals are not in toney, upscale suburbs, but in poorer suburbs where the majority of residents are Latino, black, and more often than not, foreign-born. In almost all cases they are uninsured.

The government has played a big role in providing even the semblance of medical care for millions. In fact, the federal government is the nation's biggest health care provider. It foots the bill for 40 million elderly and disabled Americans with Medicare, and nearly 40 million poor through state and federal Medicaid. More government money is spent on health care than is spent by several European nations combined. The tab comes to nearly 20 percent of the country's GDP.

For a while during the 1960s, government health officials and private health providers believed that the expansion of employer health insurance plans would make public hospitals obsolete in the coming years. That was a pipe dream. The combination of Medicaid payment cutbacks, the wholesale shift of patients to community and public clinics to save dollars and fierce competition from private hospitals for Medicaid patients resulted in a plunge in revenues for public hospitals. But during the same period the number of uninsured soared to nearly 50 million.

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