From the boroughs of New York to the barrios of Los Angeles, public healthcare is getting a makeover. Financially squeezed municipalities are turning to the private sector for help in running hospitals and clinics.
Increasingly, the federal government, states and local authorities see "privatization" as a way to preserve and improve public services. But privatizing jails is one thing. In healthcare, it's another story altogether.
New York's effort to turn over three public hospitals to private hands has caused an uproar among unions, community leaders and public health advocates. New York being a diehard union town, some opposition is to be expected. This year New York City Health and Hospitals Corp. has eliminated 8,000 workers from its 38,000-member work force. More reductions are feared once private operators take over.
City officials have disclosed a tentative agreement to lease one of New York's 11 acute-care hospitals to a private, for-profit chain. Two others remain up for bid. Although it's been almost a year since the mayor began seeking private partners, debate continues over access to care for the poor and quality issues.
Just last month, state lawmakers heard testimony from numerous groups questioning or opposing the decision to lease Coney Island Hospital to for-profit Primary Health Systems, Wayne, Pa. A second hearing is planned.
Unlike the situation in New York, Los Angeles County's privatizing efforts haven't been met with a general public outcry.
That's probably because Angelenos expected much worse. For years they had heard about the fiscal crisis threatening the entire county healthcare system. Last year they were told the flagship LAC-University of Southern California Medical Center in Los Angeles would be closed.
It was spared. But in return for a multimillion-dollar bailout from the federal government, Los Angeles agreed to downsize its hospitals and focus on outpatient care.
The county Department of Health Services-the chief advocate for the poor-has decided outpatient care is best delivered through public-private partnerships at 28 of its 29 clinics. Private organizations that are already operating six county clinics have improved services at those facilities, reports indicate. The county has earmarked only one of six county hospitals-a rehabilitation facility-for takeover by a private operator.
Although unions have protested downsizing and layoffs of county workers, so far there has been no massive objection to privatization. Service Employees International Union board members removed Gilbert Cedillo, a militant SEIU leader who led the protests.
David Langness, longtime observer of the county system and chairman of Homeless Healthcare-Los Angeles, an advocacy group, said this may be the relative calm before the storm. There is "a general anger in the community over privatization," he said. That may crystallize as the county begins funneling Medi-Cal (the state's Medicaid program) patients into HMOs in a program called L.A. Care that's set to begin in December.
"An enormous backlash is waiting to happen," he said.
Here, we present the stories of two cities: one where tensions are simmering and another where efforts to privatize are being fought every step of the way.