Last ditch try to stop reform plays on lawmaker vanity

Opponents of more efficient government refuse to go quietly in the waning days of the 2011 regular session of the Louisiana Legislature, in one instance trying one last move to reverse a policy defeat many years in the making with an appeal to pre-election legislator vanity.

On the surface, SB 207 by state Sen. Willie Mount primarily appears as a way to provide reporting on the implementation of the state’s nascent coordinated care network. As previously noted, such systems to provide care for the indigent exist commonly among the states and, when implemented correctly, do provide better care at reduced costs.

Presently, Louisiana operates under a much less efficient fee-for-service arrangement, which encourages quantity of provision over quality.

But many providers and the charity hospital system prefer this present regime because it allows them to increase billings, some wasteful or unnecessary, increasing their revenues but costs to both state and federal taxpayers. They see, and fought the implementation of, the new system as a threat demanding more effort out of them through actual demonstration of the quality of their services.

Mount and others of these interests’ legislative allies understand the usefulness of SB 207 as a means to stop the transformation because it also has a provision placing a legislative veto over further program rollout, by majority votes of various legislative committees, in the first quarter of 2014 than would end the conversion by the end of 2014. A mixture of motivations lie behind their gambit: philosophically believing in larger government and therefore its active involvement in health care, wanting to have available more state jobs and money to be distributed through the charity system to be able to take credit for this, professional alignments with provider interests, and/or pique at Gov. Bobby Jindal for having successfully taking a previous tepid reform effort passed by the Legislature that would have continued the present model (so-called “medical homes”) and within the language of the law transformed it from a money-goes-to-the-institution to a money-follows-the-patient system, which they bitterly resist.

On a theoretical level, SB 207 could cause concern because of the legislative micromanaging it empowers at the expense of efficient government. Either the Legislature needs to set detailed policy, or, if it feels it lacks expertise to create a detailed legal superstructure that allows for efficient day-to-day managing, it needs to leave that in the hands of the executive branch and accept those policy outcomes. A legislative veto of this kind, or trying to have it both ways, simply invites the kind of inefficient government that Louisiana has made legendary. An executive branch cannot execute the law if the legislative branch keeps inserting itself to the effect of changing that law constantly.

If the Legislature really wanted to set exacting policy in this area, it would change the law, which no doubt reform opponents would like but they lack the votes to do so. Or, in appropriations bills they would be specific, detailing exactly where money goes by program or the kinds of cuts made instead of employing nebulous phrasing leaving these up to the Administration (through which opponents hoped would force scrapping of reform implementation when this was done in committee this year, but instead the Jindal Administration turned it on them by saying in that case cuts would come in ways that detract from their reelection chances). But, again, they lack the political power to specify reform as an area not to be funded.

So, they put in the reporting requirements as a way to try to create an excuse for a vote to stop reform – and, not surprisingly and hypocritically, current law requires none of this kind of reporting presently from the participants in the current system, much less any from the charity system. This also makes the Legislature look like it’s taking its business seriously. And, by putting in the legislative veto, it serves not just as have a mechanism by which to stop reform, but also attracts legislators who aren’t paying attention to the real issue but are all amped up on the idea of “legislative independence” with this instrument of legislative power, which can’t hurt in an election year where many want to go home and show they’re not rubber stamps.

Thus, on a political level, the bill is bad because it is a wolf to provision of better indigent health care more efficiently in the sheep’s clothing of legislators trying to show off their flexing muscles. It does not deserve passage alone on its theoretical difficulties, but the avenue it provides to sabotage better provision of care for the indigent more efficiently for taxpayers, in order to satisfy greedy special interests and self-interested legislators, magnifies its lack of merit.