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Emergency Medical Care and the Public Purse

Robert E. Tranquada, MD
JAMA. 1996;276(12):945-946. doi:10.1001/jama.1996.03540120023012.
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The issues raised in the article by Cornwell and colleagues1 in this issue of The Journal are particularly poignant for Los Angeles County, with its 87 cities, population of 9.2 million, and a county budget in excess of those of 42 of the states. A closer look, however, reveals that there are lessons and portents for much of the rest of the United States. The threatened closure of a critical community medical resource in order to meet politically guided budgetary priorities at a time of enormous change in the financing and organization of health care is not a unique phenomenon in the United States today.

There are unique circumstances in Los Angeles County. The population continues to grow as the arithmetic sum of major Euro-American flight, immigration dominated by the Pacific Rim countries, and a substantial birth rate, particularly among newly arrived groups. In 1994 there were 220 000


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