Kennedy
has tried over the last several years to make himself a cottage industry about
running state government efficiently and not wastefully. His specialty has been
to repeat
endlessly some bromides along these lines that, at best, are hit-or-miss in
value, in part because some suggestions are too simplistic to work, and others
of them already are being done. Typically, such recommendations have little or
nothing to do with his actual job title, because he’s always seen that as a
springboard to higher office.
This
has driven him to a frustrating inconsistency reflected both in terms of
general ideology and on specific issues. A
decade ago, as the sitting Democrat treasurer he was running as a liberal for
the Senate seat eventually won then by Sen. David Vitter. Half
a decade ago, he had transfigured into a conservative, having switched his
partisan identification prior to his last treasurer reelection, to challenge unsuccessfully
for the seat now
slipping away from Sen. Mary Landrieu.
And
his position on issues often appears on the surface to be determined by their relative
political convenience more than any underlying belief system. For
example, he recently criticized a bond refinancing deal by the Gov. Bobby
Jindal Administration when eight years prior he had felt favorably about an
identical deal. Or
last year he caterwauled about a deal that went sour on the state when six
years earlier he had showed no qualms about initiating it. And while on issues
where poor spending choices are involved, he’s
vocal on some, but then curiously
silent on others. This creates the lamentable perception that he goes
whichever way the winds blow, no matter how contradictory with his past record
this might be, to cultivate an image that he is the guardian of the public weal
in the pursuit of greater ambitions.
Recent
remarks he has made about the deals made by the Jindal Administration, which will
net the state in savings somewhere around $140 million this year, $75
million the next, then probably $150 million or more beyond that, exemplifies
the sour grapes attitude he exhibits when cost-saving ideas of others are
implemented to the neglect of his in state government. Rather than celebrate
this arrangement, which removes Louisiana as the only state in the union with a
substantial portfolio of public-owned, state-run hospitals and where comparative
evidence suggests outcomes will improve as a result, Kennedy keeps trying
to throw cold water on it for what turns out to be spurious reasons.
Speaking
to a group in Shreveport where the issue of the changeover at the Louisiana
State University Health Sciences Center – Shreveport and its Monroe counterpart
E.L. Conway Medical Center came up, Kennedy incredibly dismissed the cost
savings aspect altogether, characterizing the transformation at the beginning
of October as a strategy to expand Medicaid to bring in more money. He also
pointed out that the deal was subject to final Centers for Medicare and
Medicaid Services in terms of expected reimbursement levels, echoing his latest
opinion
piece of the kind regularly floated on the state’s Treasury website and
which he circulates to the state’s media for their publication
In
essence, his argument is that (based upon the remarks of the new operator of
the two hospitals, the only one that does not have previous health care
facility operator experience) that there are no operational savings and that it’s
all just an accounting trick. And, an accounting maneuver he argues that has
yet to gain approval, which he equates to some past efforts that backfired.
Yet
the assertion that the only savings might come from accounting gimmickry is on
its face absurd. For example, all hospitals undergoing the process have shed redundant
employees (only 86
percent to date rehired with lower headcounts in all cases) so this money
must be going somewhere (a result consistent with the literature that shows how
the typical privatization of public hospital operations reduces costs by 10
percent). Let’s argue that, even with escalator clauses in the lease payments,
that what would be “savings” from this increased efficiency instead becomes “profit”
for the operators (even as some of them operate as nonprofits). If the state
thinks there is too much of its and wishes to recapture this beyond the
escalator clauses, then when the next lease comes up (for example, for these
two hospitals in 2023) then it can negotiate upwards the next lease. But, for
now, it seems satisfied with the current financial arrangements.
Also,
Kennedy’s view on this is far too restrictive and narrow that misses other
savings in other parts of government caused by the deals. For example, Jindal in
his own opinion
piece has pointed out that the Legislative Auditor has determined the partnerships
will reduce the state's retirement system debt by $300 million and lower the
annual cost burden of the retirement system to government agencies by $82
million. Kennedy ignores this when he makes the claim there are no “savings.”
As
far as the applicability of the funding mechanisms goes, state
officials report that CMS already has approved of the same kind of deals
attached to the pioneer institution in this process, the absorption of charity
functions by Baton Rouge’s Our Lady of the Lake Regional Medical Center that
already has been consummated. So it seems highly unlikely that the federal
government suddenly would do an about-face and deny the use of an allowable
cost by a provider, a lease payment for facilities, a component in calculating reimbursement.
Kennedy’s examples give about past CMS denials or reversals concern unrelated
matters.
Kennedy
also has led a chorus that finds
issue about reporting requirements for these institutions, claiming there
will be less transparency now with these deals. Again, this assertion flies in
the face of reality; not only does the state retain full authority over
auditing matters pertaining to the contracts and the parties to it face the
same oversight of financing mechanisms by the federal government, but an
additional layer of transparency may be added by moving these operations out of
the shadow of state government: filings to the Internal Revenue Service will
provide details that state government operation allowed to be obscured
(depending upon the accounting treatment of subsidiary and consolidated operations).
Actually,
that aspect doesn’t seem to concern Kennedy as much as that operators now may
not have to reveal specific salaries or equipment purchases, which by state law
are public records under state operation. But why should they? They are private
concerns so what’s the compelling government interest here? (And some of this information
already is available; for example, IRS Form 990 reveals the salaries of top
officials for the nonprofit operators.) Why should they be treated any
differently than all of the other health care providers that Louisiana pays,
from the substantial, like Molina Healthcare Systems that gets hundreds of
millions of dollars from the state currently to process Medicaid claims, to the
smallest, such as home health care agencies whose revenues come entirely from
state government?
In
other words, this complaint also is a red herring. Unfortunately, this style typifies
Kennedy’s governing approach, where no matter how flawed are some of his money-saving
policy suggestions he ignores the evidence against them and continues to plug
them endlessly, but with those that don’t come from him he relentlessly
criticizes them even as the facts don’t support his contentions.
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