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30.1.10

LA Democrats increasing their slide into irrelevance

As if we needed more proof that Louisiana Democrats were sliding ever further into irrelevance, note the events leading up to and at the party’s state Central Committee meeting this weekend.

The party has fared poorly in the past few years; since 2003, it has lost 25 of 33 statewide and Congressional contests plus its majority in the state House of Representatives despite continuing to have a plurality of state registrants to vote. It now only holds one of two Senate seats, one of seven House of Representative seats, and two of seven statewide offices.

Of course, the reason why is that the party’s issue preferences are out of touch with the majority of Louisianans and the liberal ideology it espouses is seen through as lacking and invalid by that majority. So what is the party’s response?

Well, to tackle the hardest-hitting issue to come along in the state since former Gov. Huey Long decided to share the wealth – call on Republican Gov. Bobby Jindal to sue a sports league for an overbroad use of a trademark. This comes on top of another barnburner – criticizing Republican Sen. David Vitter for not being critical enough of and accusing him of tacitly supporting half-cocked conservatives who wanted to prove to the world that Democrat Sen. Mary Landrieu’s phones were in good working order.

While Louisianans are concerned about Democrat policy featuring runaway deficits, the threats of a ruinous government takeover of health care provision, and an unnecessary economy-killing environmental regime based upon falsified science, and foreign and national security policy that views the world as it wants it to be, not as it is, all the state Democrats can offer is aspersions on Vitter (who is making threats against the National Football League’s overzealous trademark protection). When Louisianans are searching for national solutions to negative job creation, slow economic growth, and the threat of higher taxes and inflation, and for state solutions to inefficient bureaucracy, misplaced fiscal priorities, and burgeoning state costs, all state Democrats can suggest is that Jindal launch a questionable and quixotic legal action?

By definition the state party’s liberalism disarms it intellectually, but veering off in these directions demonstrates it has given up completely trying to compete with Republicans on the basis of policy. Thereby becomes more pertinent as time goes on the question of just how little of a force Louisiana’s state Democrats will become.

28.1.10

Panel award no excuse not to rethink Big Charity

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The Gov. Bobby Jindal Administration just about got what it wanted from a federal arbitration panel hearing concerning federal government reimbursements for the 2005 hurricane disasters. Now the question is whether it will spend the windfall wisely.

Yesterday the Civilian Board of Contract Appeals ruled basically in the state’s favor, awarding it $474.7 million to go to replacing the old Medical Center of Louisiana – New Orleans campus, primarily known as the “Big Charity” hospital complex for treatment of the indigent and for medical education. The federal government had argued for an amount less than a third of that, arguing that much of what was claimed as storm damage in reality was decrepitude allowed in by the state unwilling to pay properly for maintenance costs over the decades.

That the decision came fairly quickly indicates the three-person panel found the state’s argument pretty convincing. Legally the arbitrators could have taken up to a couple of months to make the decision, and even longer if they felt necessary. Thus, this likely is the final word that will come out without any judicial or legislative intervention.

Now the ball is in Jindal’s court to use the proceeds most effectively. At least $300 million was saved by the state not having to put up that much more, now to be paid by the federal government. However, the overall cost of the project will be at least twice the awarded amount, so the projected state commitment of more than a half-billion dollars must be reviewed carefully.

In 2008, the Administration released a study outlining its vision of what the new facility would look like. It revised downwards more ambitious assumptions made by predecessor Kathleen Blanco that better comported to reality in terms of costs, demands, and population served. However, over a year-and-a-half now has passed since its release and conditions have changed further which provide substantial reason for the key assumptions to be reviewed which, upon further reflection, very likely will argue for the state to go back and come up with an even less-grandiose facility.

They include:
  • Demographic shifts. There is considerable dispute over just what the area’s population and its components will be which will determine the usage of the facility as the majority of its clients are predicted to be there on some kind of federal-government run insurance or reimbursement. Using even more conservative estimates, with room to grow would prove more cost-effective.
  • DSH redefinition. The Disproportionate Share Hospital payments program was changed a year ago which means fewer revenues can be drawn by a charity hospital, meaning a reduction in the number of beds may be in order.
  • National policy. One way or the other, national health policy seems driven to get the government out of direct reimbursement of health expenses, either by forcing higher costs onto the private sector and consumers or by empowering consumers with more choice and less government interference to improve efficiency. Either way, this means less business for a charity hospital.
  • Other state priorities. Competition for state one-time dollars only has been increasing, with road needs drifting upwards into the $14 billion range, unfunded accrued liabilities in pensions now approaching $17 billion, and an unknown in cost but greater demand placed upon coastal restoration. Downsizing the present facility planned could save an extra couple of hundred million dollars to be used for these purposes that might prove more cost effective than for the facility.

Instead of breathing a sigh of relief and counting its dough, Louisiana needs to reevaluate where it is going with a rebuilt Big Charity, not only taking these above factors into account, but also keeping in mind how the purpose of the facility, which really primarily should be medical education and not care of the indigent, plays into the overall redesign of health care that Jindal has pursued in piecemeal fashion. An option that needs to be taken far more seriously than to date the Administration has is not to build an entirely new facility but instead to renovate the old. Jindal has stressed wise stewardship of funds as a hallmark of his term; he should not allow special interests or avoidance of critiquing his own previous work to prevent use of a rigorous application of that principle to recreation of a permanent state-owned hospital in New Orleans.

27.1.10

Save LA money by dropping unneeded lt. gov. office

As a number of folks rush to crown Lt. Gov. Mitch Landrieu the incoming mayor of New Orleans even without any election having taken place, Gov. Bobby Jindal has come up with an excellent idea on how to handle any future vacancies in the state’s number two job: don’t have any by abolishing it.

Predictably, some politicians expressed disapproval without really telling why, but the advantages of this would make a lot of sense. In order for this to take effect before the next round of elections, two-thirds of each chamber of the Legislature would have to agree to amend the Constitution and to schedule the popular election for this fall’s election date (concurrent with school board elections, among others), where it must gain majority approval.

Principally, this would save money. Frankly, the lieutenant governor has little to do now while pulling down over six figures in salary. Nominally, he heads the Department of Culture, Recreation, and Tourism, but there’s actually a real secretary to do those things. Eliminate the lieutenant governor’s job and the staff that goes along with that, and this year’s budget indicates over a million bucks a year could be saved. (In fact, Jindal appears to want to eliminate CRT as well and send its functions elsewhere which would make good sense as well since in some ways it’s duplicative; for example, both this department and the Department of State have responsibilities for museums.)

Not having someone sitting around waiting for the governor to vacate the office or become incapacitated (or in Louisiana, leave the state borders) is not unprecedented among other states. Seven do not have one and one is not popularly elected, and of the 43 only 25 have legislative responsibilities. Jindal’s proposal would be to have the Secretary of State succeed to the governorship in time of vacancy, currently the office in the state with the least amount of policy-making duties, which is done in Oregon and Wyoming, in addition to the commonwealth of Puerto Rico.

About the only justification to have the office is because it offers one more elective job for politicians and an increased chance to live off of taxpayers. That’s the only (bad) reason why legislators may balk at this if proposed by Jindal, since it will be one less outlet for a term-limited legislator to find refuge when being forced out of his current legislative office. This is in strong contrast to how governors probably see its value, where, as exists currently, someone of a different party can take shots at the governor while having little responsibility himself for policy-making and therefore having to deal with the consequences of his suggestions. But with Landrieu possibly out the door, the biggest obstacle lobbying against such a change (a sitting lieutenant governor) may become removed.

When Louisiana rid itself of its elections commissioner a few years ago, it went from being the state tied with the most separately elected executive officials (not including education). Moving further down the list is an idea whose time has come, and Jindal should pursue this with some vigor.

26.1.10

New B.R. indigent care policy needs expansion statewide

Gov. Bobby Jindal is making the right move, but now he needs to make the big move when it comes to realigning the way the state provides health care to the indigent.

The Jindal Administration made formal its commitment to discard the charity hospital model in Baton Rouge by making permanent the ongoing move of functions of the state’s Earl K. Long Medical Center to the private Our Lady of the Lake Regional Medical Center. By 2014 the state’s run-down facility would cease any provision, and all but prisoner care and obstetrics would be done by OLOL or from state-leased facilities from it. The state would pay for some of the new construction and operating costs.

This will save the state perhaps $400 million in costs to build a new facility due to the decrepit nature of the present facility. Still to be worked out is the disposition of some of EKL’s satellite clinics which to receive federal funding for treating Medicaid patients must be affiliated with a hospital and the treatment of prisoners and obstetrics, but surely the state can make arrangements with other providers for these. Besides OLOL essentially taking over treatment of the indigent, it will become the major source of medical education for the area.

25.1.10

Jindal can remain unscathed despite tough fiscal times

(From five years ago, I take it back.)

A recent news article asks how long Gov. Bobby Jindal can continue to enjoy high popularity given budgetary difficulties in the state. The answer is, unless he doesn’t pay attention to certain things, a very long time.

For the fact is, a mildly conservative public in the state approves of an agenda implemented by Jindal to this point that has been mildly conservative. Thus, the majority only may begin to question Jindal’s handling of potentially bad budget deficits if he begins to cut what are considered services of some importance which also are seen as presently well-managed which cumulatively begins to affect a substantial number of the citizenry.

So far, that’s not been the case with one possible exception. Because of constitutional limitations, with two exceptions cuts to date across the budget have been broad and not very deep. Since, and with good reason, Louisiana state government in general has been seen as bloated and unusually inefficient and the vast majority of the citizenry has seen cuts that heretofore have no real impact on their lives, there’s little reason for them to be upset with Jindal over these, especially if the alternative is raising taxes.

For one of the two areas that are forcibly disproportionately cut, those hitting higher education in sum bring little negativity to Jindal. Being a state of lower educational attainment and quality does tend to make the public as a whole less likely to want to support higher education, but more of this has to do with self-inflicted wounds by higher education itself. It insists on running an inefficient governance system that results in one of the highest number of institutions and highest per capita costs in the country while charging in the middle range of tuition. Until it can explain these inconvenient facts to a skeptical public or change them, Jindal will not be harmed politically by this issue.

In the other, health care provision, the vast majority of clients in this area typically are poorer and less educated and thus susceptible to the false promises of liberalism, to which Jindal does not subscribe. While some of this group may be adversely impacted by these significant cuts, in large part they already disapprove of Jindal for his insistence that people expect less out of government and society and do more for themselves. So, again, political damage can be limited here.

Yet this also is a partial exception, in that if cuts here aren’t smart and appear to cut off truly necessary services to the deserving, Jindal could be perceived as too mean-spirited. Therefore, in handling this area, the largest by far in absolute dollars removed, Jindal must appear to be making cuts fairly among different areas of client support that do not appear to risk lives and health.

This he can do, and so far has been doing, by emphasizing the cost-saving aspects of providing a similar level of service. For an example of this, there are recent moves to close state-run institutions in favor of decentralized, private sector group homes for the developmentally disabled where dollar figures demonstrate the captured saved money. However, this must continue; for example, while the Resource Allocation Model has been employed to match appropriate number of hours of home-based care to clients, it has not yet been deployed to nursing homes and until it is, Jindal can be accused of favoring private interests in that industry over patients.

Other recent developments can assist Jindal in maintaining voter popularity in tough times. The products of the Commission on Streamlining Government, now available, and of the Postsecondary Education Review Commission, soon to be available, Jindal can refer to for backup in pursuing these ideas in front of the Legislature, whose enactment of most of their suggestion will allow whatever might be controversial from them not to be pinned entirely on Jindal.

However, in reference to disproportionate cuts, Jindal cannot use the excuse that he is hamstrung by the law and Constitution. Last year, he proposed reviewing the nearly 400 dedicated funds and to change procedures dealing with a budget deficit position that would have induced greater flexibility into the system, but could not win the Legislature’s support. He must try again to show he does not want to live by this system, change of which will reduce the burden on health care and higher education and create better prioritization of state spending.

Take this course – without raising taxes – and Jindal largely will be immune from any ill-effects on his public support caused by fiscal difficulties. Indeed, should he manage to pull that off, he will gain far more accolades – and political capital for any future electoral ambitions – than had he and the state had the fortune of more pleasant budgetary times.

24.1.10

Tough love should cause ending the charity system

Often years ago, but not recently, I have written that Louisiana needed “tough love” from the federal government to do the right thing. That was commonly the case under the administration of Gov. Kathleen Blanco which put growing government ahead of empowering people, the correction driven by the presidency of George W Bush. This legacy continues, now under Gov. Bobby Jindal, derived from one of the last acts of the Bush Administration.

That was a new rule regarding the use of Disproportionate Share Hospital funds, which is the federal government’s way of reimbursing hospitals for providing Medicaid services as the clients typically the facilities little or nothing. Starting this July, it restricts the kinds of procedures for which reimbursement will qualify.

Louisiana will feel the impact of this change far worse than any other state in terms of health care financing because no state approaches it in the amount of Medicaid DSH funding that goes to government-owned institutions. The state has stubbornly stuck by its charity hospital system which, instead of decentralizing and privatizing it for efficiency sake, creates worse outcomes and higher costs. It’s predicted to be $137 million, but private providers also will suffer and will look to the state either to make up the difference or close their doors in some cases.