Vitter pushes Blanco to do right for taxpayers, indigent

Thus, it takes another push from the federal government to make Louisiana do the right thing when it comes to indigent health care. Sen. David Vitter, who said his message merely echoes the sentiments of Housing and Urban Development Secretary Alphonso Jackson, argued in a letter to Gov. Kathleen Blanco and Jackson that the federal government should not pitch in $300 million to build a new state-owned hospital in New Orleans unless it also revamped its indigent health care system away from its institutional bias to a money-follows-the-person regime.

With the widespread damage from the 2005 hurricane disaster brought to the existing Medical Center of Louisiana New Orleans facilities (better known as “Big” Charity Hospital), the state decided it should build a whole new complex around downtown rather than renovate permanently the existing one. That’s not a bad idea, but the state rolled out an extremely ambitious, much expanded plan but which depends upon being attached to a Department of Veterans Affairs veterans’ hospital. The federal contribution to this would be $300 million.

However, Vitter signaled that the state should not get disbursement of that money unless it also agreed to scrap any vestige of the money-given-to-the institution charity hospital system of indigent care. That system (found only in Louisiana) is less efficient and produces poorer outcomes with fewer services than the model the state is being urged to adopt by the federal government, but Blanco and other state officials have put up strong resistance to genuine system reform because it would reduce a reduction of scope, size, and authority of government, and would steer money away from the special interests backing these politicians.

(While it’s true that Vitter is a Republican and virtually all the opponents of reform are Democrats, it’s not really a partisan issue. No less than Democrat stalwart and former Sen. John Breaux has come out in favor of real reform. Rather, battle lines have been drawn between big government practitioners of politics as usual who have run Louisiana for decades and those who wish to transfer power from government to the people, in this case clients of indigent health care. For her part, Blanco showed how inflexible and lacking in creative thinking she is with her reaction to Vitter’s letter: “I simply have a hard time believing that Secretary Jackson, who deeply cares about the low-income population, would go along with such a plan to inflict so much potential harm.”)

The two issues relate: much of the justification for an expansion of Big Charity rests on its continued use as the processing warehouse for indigent care; give the indigent their own insurance they can use at a variety of places rather than giving them a location at which to appear when needing care and traffic at Big Charity will go down. The fact that the greater New Orleans area also will be down at least a couple of hundred thousand people perhaps for the foreseeable future in a market with too many beds prior to Hurricane Katrina does not seem to have made an impression of those who want more beds in the new facility.

Blanco, the good old boys around her, and the special interests benefiting from the current system are like junkies who need their crack removed to start their recovery – in this instance, with denial of the federal funds for the grandiose Big Charity. Instead, the federal government could pledge to give that amount to the state for transition costs (which would require some redirection of funds between HUD and the Department of Health and Human Services which might have to involve Congress) while the state scales back on its idea for the new complex that would not require that federal money. Add to that no possibility of federal waivers to redirect those dollars going into the state’s Medicaid program and no additional transition dollars unless the state junks any element of its current system in any redesign.

Vitter deserves applause for standing up for Louisiana and American taxpayers and for those who need indigent health care in the state; hopefully his tough love and the support of Jackson will get Blanco and her cronies to put people ahead of politics on both of these issues.