EDITORIAL IN POOR HEALTH DECADES OF BAD POLICY COME BACK WITH A VENGEANCE.

DECADES of misguided policy at all levels of government, coupled with a slowing economy and diminished tax returns, have brought Los Angeles County's public health care system to the brink of collapse.

Partly because of its hospitable climate and partly because of its hospitable public policies, L.A. has become a haven for the poor. Now, there are so many poor people with so many needs that the schools, the job markets and, most worrisome, the health system are overwhelmed.

Local government faces a harsh reality: There are too many people in need of public benefits and not enough taxpayers to cover the expense.

Since 1995, the federal government has bailed out Los Angeles County's public health system to the combined tune of $2.2 billion. It took that massive infusion of cash to keep the hemorrhaging system solvent, but now, with the recession and the war on terrorism, the federal government has turned its attention elsewhere, and turned its back on L.A. County.

As a result, the county health system faces a $688 million deficit by 2005-06.

In a desperate effort to balance the books, the county Board of Supervisors has embarked on an overdue effort to save $100 million in waste and inefficiency, a painful belt-tightening that could leave the area's poor without any medical care outside of basic emergency service.

Under a plan approved Tuesday, the county would close five health clinics, including ones in Burbank and North Hills. It would also reduce staff size in the obstetrics unit at UCLA-Olive View Medical Center in Sylmar and close a rehabilitation unit at High Desert Hospital.

Longer term, county officials are considering privatization or even dismantling the system entirely by shutting down all hospitals and clinics except for emergency room and acute care facilities.

Facing the very real prospect of bankruptcy, the county government is now unable to help its most helpless, the poor and uninsured.

And neither Washington nor Sacramento, which bear no small share of the burden for this crisis, are willing to spend the money to keep county health care afloat.

In addition to plenty of local bungling, it's the federal government's inability to control the borders and Sacramento's long-standing policy of making California the land of the handout that have created the awful imbalance between those who pay into the system and those who draw out from it.

But President George W. Bush and Gov. Gray Davis have given no indication they will come to the county's rescue. After helping to create L.A.'s mess, the state and federal governments are leaving the cleanup to the county alone.

Local taxpayers will spend millions learning a tough lesson about the limits of government. But the human toll of a county with many needs and scarce resources will be far greater still.

The poor, of course, will pay the heaviest price from sharp reductions in the availability of public health care. But over time, everyone will feel the consequences of a community in decline, unable to care for its neediest, unable to improve the lot of its citizens.