The chairman of West Contra Costa's health care district board was exactly right Thursday night as directors voted to start shutting down Doctors Medical Center on April 21.

"This community is getting screwed at the end of the day by a system that has nothing to do with the people in this room," said Eric Zell.

Indeed, right up to the end, even though most have known for months that closure was inevitable, the quality of care has remained excellent and the cost of providing service has been well-controlled.

The hospital doesn't have an expenditure problem; it has a revenue problem. Hospitals such as Doctors that serve primarily Medi-Cal and Medicare patients don't receive full reimbursement for the cost of care.

While the Affordable Care Act helped more Americans receive health services, it doesn't ensure everyone equal access. That wasn't a political option for President Barack Obama when he squeezed his compromise plan through Congress in 2010.

So, with few patients with private insurance, Doctors lacks a way to balance the shortfall from government-based coverage. That, more than anything else, explains why the hospital, financially challenged since the mid-1990s, has for seven years been unable to close an $18 million to $20 million annual operating shortfall.

The county, state and some other East Bay hospitals stepped up in years past to help close the gap. Then the health care district started floating bonds to cover ongoing expenditures, an irresponsible borrowing scheme that will burden future taxpayers for past operational costs.

It all finally caught up. The district is running out of cash and has run out of options. Every two weeks that it stays open adds roughly $1 million to the debt.

None of this if fair. Not our health care funding system. Not the huge service hole that will be left in a heavily populated region. Not the debt that will haunt taxpayers until 2027.

Right down to the wire, hospital doctors and staff kept hoping for a savior. In respect for that, district directors set the closure date one week later than originally proposed to give a former Southern California hospital administrator another crack at putting together a deal.

This is the same guy who recently claimed he had a billionaire investor ready to save Doctors. That turned out to be a farce. The chances he'll now be able to come up with cash and a real plan that stops the hemorrhaging are slim to none.

But, after all these years of struggle, directors will be able to say they exhausted every option.


Reposted from Contra Costa Times.