Behind the County Health Woes: An Outmoded Government : A last-minute federal rescue should not lessen the need to reinvent a deeply flawed structure of governance.

Something is seriously wrong with Los Angeles County government when it is reduced to begging to save its health, welfare and criminal-justice systems from collapse. Luckily, the federal government will relax some rules so the county can receive the money it needs to keep on delivering services. Many of the factors that threatened to close nearly 36 health centers and clinics, and perhaps some hospitals, are beyond the control of the Board of Supervisors. But there is much more to the story--an outmoded structure of government.

The five-member board doesn’t work. Responsibilities for setting policy and actual administration of the county are so intertwined that there is no discipline in the system. Additionally, there is a confusion of priorities among jurisdictions and the county, which leads to conflict and unnecessary waste. And the delivery of whatever services will remain after downsizing, whether in health, welfare or criminal justice, will be left up to a bureaucracy that, though well-trained and capable, is too in-bred and stultified to develop alternative ways of doing things, or of conceiving goals that would enable it to aim higher.

These problems are structural. They would be there even if Sacramento had not gobbled up a billion dollars in property taxes to balance its own books. They would be there even if every member of the Board of Supervisors were a model legislator and maintained civil working relationships. They would be there no matter what the commitment and capability of the employees. In fact, it is important to recognize that the county’s crisis is not about its ability to deliver services, but about its ability to pay for them. Unless the problems are addressed, the county, its 87 cities and unincorporated areas--indeed, much of the Southern California region--may fall into an abyss from which it will never emerge.

An obvious problem is the way the Board of Supervisors operates. Its five-person organization is too small to allow for shifting coalitions, too big to allow any single member to emerge as a leader because no one is willing to allow his or her colleague to step out in front. Nor are there enough members to seriously represent the county’s diversity, whether ethnic or geographic.

Whatever the cause, the behavior of the board has been most notable for its back-biting and interference in the administration of government, to the point that any semblance of rationality that does surface in budget-making gets blown out of the water as each member accedes to the petitioners before them. Put another way, there is no constituency for saying “no.� And there is little courage to stand up for the broader picture beyond one’s district.

The behavior of the supervisors only adds drama to the inexorable trend of government downsizing and the rationing of social services. The county does not have the resources to compensate for the state’s raid on its property tax, but it wasn’t doing much to compensate for its continual revenue loss before the current crisis, anyway. It is time to take charge and rethink what’s desirable and how to realize it.

There needs to be a separation of policy and administration, and a halt to the practice of dividing everything by five, regardless of the distribution of wealth and poverty in the county. A mixed board that included some at-large members could better manage to see itself as a constituency-based body promoting countywide interests.

The county’s chief administrative officer, Sally Reed, came to her job from Santa Clara, a county whose charter places greater stress on broad professional procedures and blocks supervisors from interfering with administrators beyond asking questions of information. Once policy is set, all other communication must go through the CAO. L.A. County reformers should consider a similar approach because the county needs a strong executive, either elected or appointed, who can be held accountable, who has the administrative authority to say “no,� and to speak for the county at other levels of government.

The history of Los Angeles County is one of secession: communities securing their freedom from the tyranny of the city of Los Angeles or the politics of the county. The current fiscal crisis requires a reversal of these attitudes of separation and greater coordination. Resources must be shared more efficiently and decisions about policy must be made in concert. As it is, the City of Los Angeles is hiring more police, while the county expects to cut the number of prosecutors and judges. A similar problem is occurring in New York, where the state is cutting its court load by eliminating minor criminal offenses--the very laws the city uses to improve its quality of life.

Government employees should be encouraged to learn from their peers elsewhere and to experiment on their own. Maybe it is time the county initiated its own health-care system by exploring affordable insurance for small business--the backbone of economic growth. While it is nonsense to think the private sector can take over the county’s job without substantial help from government, there may be more creative relationships that could be fostered with the nonprofit sector, in particular.

The county may escape the destruction of its health-care system this time because President Bill Clinton needs to win California for reelection. But it would be a serious mistake to lose this opportunity to make the substantial changes needed to operate local government. It will take leadership, training, broadened horizons and the will to take control of our lives if Los Angeles is to be competitive in the future. Ignoring the prediction of what might have happened will be suicidal.