Report shows vested health care interests have no clothes

Once again, I am flattered that the Louisiana Public Affairs Research Council would take one of my ideas that appeared in this space months ago and run with it. The research outfit just issued a report that the Gov. Kathleen Blanco Administration and other political elites with vested interests in the current indigent health care system in the state are not going to want to see, but the recommendations of which are indispensable to improving outcomes and efficiency in the state’s biggest area of spending.

The report advocates putting medical education at the state’s public hospitals first, rather than the state’s current mode of giving priority to trying to get as much federal money as possible into the system from reimbursement for caring for the indigent. This change would occur through centralization of medical education in Shreveport, Monroe, New Orleans, and Baton Rouge and shedding the state’s interest in the other state-owned facilities. It also would broaden outreach opportunities for education facilitated in the non-government sector to take advantage of the latest knowledge.

It drew the usual pithy, shallow response from the Louisiana State University system which runs these hospitals, “If the Legislature does what PAR wants to do, the safety net would be dismantled,” and criticizes the statistics involved: mind you, only the state ever seems to have trouble with these numbers while every other public and private party involved with the issue affirms them. Most condemnatory from the report, which the LSU system can’t explain away, is that, unlike public hospitals in other states that show substantial increases in service volumes, Louisiana charity hospital trends since the mid-1990s show significant decreases in services delivered, although budgets continue to increase.

Further, the Louisiana charity system is heavily subsidized with state and federal funds. It relies on Disproportionate Share Hospital (DSH) funds and Medicaid for more than 80 percent of its operating revenue, compared to less than 40 percent for public hospitals in other states. Which all goes back to the questions LSU never wants to answer, and never has: why is it that Louisiana is the only state in the Union which maintains this two-tiered system; why is it that all other states have an adequate “safety net” structures without charity hospitals and Louisiana must have charity hospitals and rely on huge public expenditures? We’re still waiting, LSU ….

The report gives more ammunition to building a reasonably-sized new “Big Charity” in New Orleans, as well as a new Earl K. Long facility in Baton Rouge. It also backs up arguments made by those wanting to reform the system from its current money-goes-to-the-institution to the better money-follows-the-person regime. The state continues to make an (ineffective) case for a grandiose new Big Charity, and it is barging ahead with legislation that does nothing to reform away the two-tiered system.

As special interests more interested in retaining power and privilege dig in their heels at truly needed reform, this timely report adds to revealing both the weakness of their cases and the nakedness of their desires.