Hospitals have kids covered

I wish California children were doing as well as California children’s hospitals.

Even as the Golden State has maintained the nation’s highest child poverty rate and struggled to fund schools, it has developed a system of children’s hospitals that occupies a parallel California in which kids’ needs actually come first.

California has 13 children’s hospitals — eight private not-for-profits and five within University of California medical centers. Collectively, they receive more than 2 million visits from children annually.

In these hospitals, you can see California’s ability to be generous to a fault.

Children’s hospitals offer a rare place where California’s rich and poor mix; the surgeon who operated on TV comedian Jimmy Kimmel’s son also performs surgery on kids on Medi-Cal, the name for California’s Medicaid. Indeed, nearly two-thirds of children’s hospital patients are eligible for Medi-Cal, compared with about one-third of patients in community hospitals. Virtually everyone in children’s hospitals is covered because all California children are insured via Obamacare and state law.

Children’s hospitals thrive on this mandate to treat everyone: While they lose money on Medi-Cal patients, they compensate by being aggressive with commercial insurers and building powerful fundraising operations.

And like other interest groups, children’s hospitals have won taxpayer dollars through the ballot. In November, California voters are all but certain to approve Proposition 4, the third general obligation bond for children’s hospitals in the past 14 years.

Through such support, these hospitals have become juggernauts, with large medical centers, suburban satellites, top pediatric research and training programs, and well-paid executives. Their greater scale reflects the state’s health care and demographics.

Even though the number of California children has stagnated, technological advances have created new avenues for care, especially for children with difficult-to-treat diseases. And with California’s population aging rapidly, hospitals are handling more Medicare patients. Because Medicare reimburses at higher rates than Medi-Cal, it’s inefficient for traditional hospitals to accommodate the special needs of children on Medi-Cal.

So today’s kids are increasingly referred to these specialized hospitals. As a Southern California father of three, I’ve been redirected to Children’s Hospital Los Angeles by pediatricians, afterhours clinics and a hospital ER for my kids’ minor maladies — a broken finger, a toy piece stuck up a nose, a painless bit of groin swelling.

The children’s hospitals in Los Angeles and Orange counties, I’ve found, are expertly designed for juvenile happiness. My only problem with visiting the Children’s Hospital Los Angeles outpatient center in Arcadia was tearing my sons away from the most robust entertainment system they had ever encountered.

These comforts, funded by private donations, reflect a growing marketplace where parents have choices. Competition also comes from lower-cost retail clinics and tele-health services. That’s healthy. So is pressure for greater scrutiny of the hospitals’ operations and quality.

You probably won’t hear all this context before November’s vote on Prop. 4, the $1.5 billion bond for children’s hospitals. But the measure raises an important debate. Should we help fund these vital institutions’ capital needs through general obligation bonds? Such bonds are paid off via the general fund — a $1.5 billion bond costs $2.9 billion over 35 years — which cuts into money for other programs that serve children.

I’d prefer a dedicated tax for children’s hospitals to avoid debt service costs. But securing that might be politically impossible. And, to the hospitals’ credit, spending on previous bonds has been responsible. Prop. 4 is also small compared with November’s $8.9 billion water bond.

Yes, you could ask whether children’s hospitals offer too much. But the better question is why other programs for California children offer so little compared with children’s hospitals.