Welcome hospital plan defeat reveals interesting dynamics

The state got a good, unexpected Carnival throw last week from the Louisiana House of Representatives when it failed to muster a majority to allow funding for any aspect of a new Louisiana State University hospital in New Orleans.

Constructing a replacement for the ravaged existing facility got caught in the crossfire of three issues. First, the mail balloting of this ensued when the Legislature’s Joint Legislative Committee on the Budget overrode a Louisiana Recovery Authority decision to send forward only $74 million to plan and buy land for it, instead approving $300 million that could have started the building of it. Second, given the surplus of hospital beds in the metropolitan New Orleans area, there is great questioning whether such a facility on the scale it has been conceptualized is needed. Third, supporting the grandiose version was seen as validating the present indigent care system while refusing to redesign health care in any meaningful way in the state, holding onto the inferior money-given-to-the-institution rather than money-follows-the-person concept.

The 50-37 defeat provides an interesting window on the political scene because it was unexpected. First, it shows the GOP really is getting organized, as most of the votes against the plan came from near-unanimity on its members’ parts, rebelling against the committee comprised almost totally of Democrats (indeed, of the few Republicans on it of over 20 members, only state Rep. Steve Scalise can be considered taxpayer-friendly).

Second, it lays bare the politicized nature of higher education governance in the state, since those shocked at the failure of it to pass including Gov. Kathleen Blanco blamed the Louisiana State University system, represented by its Board of Supervisors, for not “lobbying enough” for the measure to pass. A very unfortunate fact of life in Louisiana is academic institutions, because of a political culture that overemphasizes special interests and underemphasizes merit, are unusually influenced by political decisions, in this case because the indigent care system in the state largely was put into the hands of the LSU system.

Third, it demonstrates the weakened nature of Blanco and the politics of post-hurricane recovery. She easily could have tried to cajole some people to vote in support – in fact, it was really no-shows that prevented passage who with a simple gubernatorial reminder well might have had the motion carry. However, the LRA largely is her tool, so she had disincentive to lobby for a decision that countered its. But also, during this election year with the stakes so high and her political capital running so low, she will want to save her efforts for matters that have a wider and/or more visible impact on a large portion of the Louisiana population.

However it happened, it constitutes an entirely welcome development and buys more time for sharper thinkers and public concern to build to engineer true health care redesign.