County Supervisor Zev Yaroslavsky on Regionalism, Healthcare, and the Challenges of Civic Leadership

Supervisor, as we've discussed often in the past, the fiscal position of counties within the State-local fiscal arrangement in California is a weak one. Is there any promise of change that would give more predictability and stability to the revenue stream of counties like Los Angeles?

No. In fact, the old refrain continues: in bad years, the State raids local government, and in good years, they leave it alone. But they never return the money they've raided in previous bad years. In the early 1990s, Sacramento raided locals statewide of over $3 billion in property tax revenue. And even with last year's $10-billion surplus, they didn't give it back. It's an ongoing problem whose weight falls on the shoulders of local government, especially counties. And for urban counties-which have such huge demands for human services-that weight is absolutely crushing.

Frankly, if it hadn't been for the Clinton Administration, in 1995 Los Angeles County would have gone bankrupt. Maybe then there would have been some State attention to the problem, but as it stands, counties are not where it's at politically in Sacramento.

Counties largely serve the needs of poor people-people that are not politically powerful, who can't hire lobbyists, who don't vote in big blocks. We represent and provide human services for the indigent, not the middle-class, and it's a lot easier to get action in Sacramento on issues that attract middle-class voters. For instance, education has the resonance it does in Sacramento not only because it's a very important issue, but also because it's a middle-class issue. Taxation is another such issue.

But providing critical healthcare-like immunizations to kids who can't vote-has little political remuneration. We are in the unenviable position of 1) being financially challenged, and 2) arguing a case on its merits, pleading to the minds of the Legislature and the Governor, not to their hearts and political pocketbooks.

It's issues like these that remind me of the words of the 19th Century British statesman, Lord Macauley, who said: "No man is fit to govern great societies who hesitates about disobliging the few who have access to him for the many he will never see."

You're on the LAFCO Board, and the financial report regarding the viability of a seceded San Fernando Valley was recently released. Give us your take on that report. What do you see happening over the coming year re: secession?

As far as it goes, the report is fair and balanced and will give both sides enough material to advance their respective arguments. It shouldn't come as a shock to anyone in Los Angeles that if the San Fernando Valley were its own city, it would be viable. If El Monte and Lancaster are viable, certainly the San Fernando Valley-which would be one of the five or six largest cities in the U.S. with a considerable economic base-would be viable. That's the conclusion they reached, and low and behold, it made front-page headlines.

The issue of how to divvy up the assets will be an issue for people to argue about until the cows come home. This is analogous to a divorce proceeding, where the Valley is suing the City for divorce and LAFCO is sitting as the judge to determine who gets the car, the kids, the vacation home in Lake Arrowhead. But I hope we don't make it more complicated than it needs to be.

I hope this issue gets to the people of Los Angeles for a vote by November 2002. I think this decision will ultimately be political, not financial. The financial issues may be complicated, but they're not a mystery. Both cities will do just fine whether they are united or divided. The issue is to get this to the people and let them figure it out. I have a lot of confidence in the people's innate ability to seperate the wheat from the chaff. At the end of the day, people are going to vote their instincts based on information that has been gathered and studies that have been done, as well as their own experience with government and whether they think they can get a better deal by seceding or whether they're better off with the status quo. Those are the issues that will be discussed at kitchen tables all over the Valley and the rest of the City in the next year and a half, and I hope the public will have an opportunity to vote on it one way or the other by 2002.

While it's been a healthy debate, it hasn't immunized a single kid from disease, it hasn't filled a single pothole, it hasn't put a single cop on the street up to this point, and "San Fernando Valley secession" should not become a lifelong industry for proponents and opponents.

Zev, the head of your County Health Department, Mark Finucane, has announced his intention to resign, as has the number-two. Give us a status report on the fiscal and programmatic capacity of the County's Health Department to meet the challenges that lie ahead.

L.A. County's health system is the most burdened and challenged in the country primarily because of the demographics of our population. Three million of our residents-our clientele-are uninsured. If our uninsured were their own county, they would be the second largest county in the U.S.

Unfortunately, when the policies of healthcare finance are promulgated in Washington and Sacramento, they're not promulgated for Los Angeles County because you can't promote regulations and policies assuming the norm is 30% uninsured out of the total population. The policies are based on the nation's overall healthcare picture, and Los Angeles always ends up with the short end of the stick.

Basically, the situation is this: L.A. County has the largest number of poor, uninsured people in the United States. For us to fulfill our core mission of providing critical healthcare to that population as the law requires, we either need more money, or we need to consolidate, synthesize and restructure our service programs, which may ultimately result in reductions in certain sectors. Twice we've been bailed out by the Federal government-once in 1995 and again in 2000-and the Clinton Administration's waiver was issued on the condition that at the end of this five-year period, we'd no longer be reliant upon Federal waiver money.

We're implementing a weaning process. Every year for the next four years, we're going to lose a significant percentage of our Federal waiver form money until we receive nothing. And we have not moved fast enough to position ourselves for that landing.

With Mark Finucane's departure, we have an opportunity to bring in a team of people who will accelerate reform and give the Board of Supervisors a set of options that both make financial sense and maintain our ability to fulfill our core mission. We need to determine the best way to go over the next four years so that when the waiver expires in 2005, we're in a position to make a soft landing, and not crash-and-burn as we almost did in 2000. While it's likely impossible to completely close the gap between demand for services and available resources, we have to at least bridge that hole through other Federal or State sources. We can't assume that maintaining the status quo for the next five years will bring us another waiver-because it won't. And unless we make some significant changes in the way we do business, I don't even think we should get another waiver.

What are those changes? Consolidating some of our services, and synthesizing some of the units in our facilities. Right now, L.A. County's six hospitals operate as six entirely separate units-each with its own administrative infrastructure-and not as one integrated system. There is no reason to have a multitude of pharmaceutical warehouse dispensaries. We don't have to provide the exact same surgical services in every one of our hospitals; we may be able to do orthopedics in one, heart in another, and appendix in another. Some may be urgent care facilities; some might concentrate more on critical care. Admittedly, this is not a field in which a politician should do too much meddling, but these are at least the kinds of things that need to be considered.

Last question, Zev. You're up for reelection, along with Gloria Molina, a little less than a year from now. But a lot of people who have supported you and who know you want to know why you didn't run for Mayor of Los Angeles. What is it about the job of Mayor and/or your present post as Supervisor that kept you from jumping in?

Well, the grass is always greener. If I had one vote for every person who told me they wanted me to run for Mayor, maybe I would have run for Mayor.

I have two passions in my public policy life. One is local government, and the other is international affairs. I had an opportunity to run for Congress a few years ago, and I chose not to. I've made my decision to stay in local government.

I love this City and County. I love the communities that make it up. I can't think of any place I'd rather be-outside of a Dodgers broadcasters booth-than serving the local government needs of this region. To be a Los Angeles County Supervisor is perhaps the greatest local government job in America, with the exception of Mayor of New York City, which has the same kind of breadth in terms of healthcare, welfare, transportation policy, environmental issues, the arts, and all the issues that I live and breathe every day. For me, this is still an exciting, challenging and rewarding profession.

In fact, I don't even consider it a profession. I wake up every morning and I feel like I'm going into battle for the right things. The Mayor of Los Angeles is a great job, and there are two great candidates running for it. But for me, it almost seemed like a lateral move.

I look forward to working with the next Mayor and the new generation of City leaders that's coming. We have a great team here in the County, and I think there's a lot we can do together to make this a better community.