The sad saga of MLK-Harbor Hospital came to a close yesterday, as the Los Angeles County Supervisors voted unanimously to shut the county hospital, which has been making headlines since the federal Centers for Medicare & Medicaid Services (CMS) found it sub-standard in January 2004. The latest tragedy was the death of a patient in the emergency room – ironically when Michael Moore was in California touting his prescription of government-monopoly health care.

CMS finally terminated MLK-Harbor’s Medicare contract after a July inspection. Falling symbolically on their swords, the LA County Supervisors posted CMS’ entire 142-page report online. Among the observations: diagnostic reports were lost, flexible endoscopes (instruments that touch mucous membranes or non-intact skin) were not cleaned and stored properly, and suicidal patients were able to seize scalpels and lock themselves in bathrooms. Nor were these shortcomings due to a lack of policies and procedures: indeed, the "Quality Assurance Data Binder" was no less than 4-inches deep with sheets of paper.

What happens next? In the short term, the county will shut down the ER and inpatient wards, reorganizing ambulance services and sending medical staff to nine neighboring private hospitals. Then, the county will contract with a private operator to run the ER and inpatient services, which it estimates will take 18 months to arrange.

A tragedy? Of course, but imagine how much worse it would have been under a government monopoly, like that proposed in state senator Sheila Kuehl’s SB-840. Under such a system, the payer and provider are blurred. The nine hospitals surrounding MLK-Harbor would not compete for Medicare contracts. Instead, their budgets (and MLK-Harbor’s too) would fall out of a centrally determined, three-year plan, generated from Sacramento (because SB-840 would “carve out” California’s seniors from Medicare into its state monopoly).

There would be at least three consequences of such a system:

1. The terrible situation at MLK-Harbor would not have come to light until much later, if ever, because the “payer” and the “provider” would effectively be the same party, and both would be embarrassed to disclose the facts.
2. The terrible situation at MLK-Harbor would have “bled” over to the other nine hospitals, because the fact that all of them would be fully dependent on the state for revenue(instead of attracting patients) would lead to a “race to the bottom” as hospital managers diverted resources from patient-care to featherbedding.
3. The terrible situation at MLK-Harbor would not have been resolved as well as it promises to be, because the nine neighboring hospitals, locked into government budgets,would have no “surge” capacity to handle the challenge.

Will the left learn a lesson from the tragedy of MLK-Harbor Hospital? Let's hope so.