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Arguments against health care redesign lack any merit

Forces of regressivity, paying more attention to the desires on entrenched interests than those of taxpayers and of the health care uninsured in Louisiana, continue to moan about health care redesign in the state.

Recently, the state forwarded to the federal government a plan that would encourage the shifting away of federal health care funds from Louisiana’s anachronistic charity hospital system and give the individuals receiving the increased options outside of that system to use these dollars. This is the model the rest of the nation is adopting, moving even further away from Louisiana’s vintage 1930s strategy of running several large hospitals and inviting the uninsured to use them – the only such system in the U.S.

However, the state did not show a lot of enthusiasm for this plan, even though the federal government said it would pay potentially hundreds of millions of dollars in transition costs. The reason, of course, is because a big bureaucracy has been created around the operation of these 11 hospitals (nine run by a state agency, the other two by LSU) and, if there’s one thing the good-old-boy-and-girl network loves in Louisiana, it is big government. By having money following the person rather than the state, this regime threatens to downsize the state’s inefficient system, and overall size of government.

There’s no escaping the fact that the present system overall produces poor outcomes using more resources than necessary. Nevertheless, it continues to have its defenders among those vested in it. Perhaps the most asinine statement in this regard comes from one of the LSU board members who, apparently with a straight face, was adamant that over the years nobody has been able to come up with a better system at equivalent cost.

Five minutes of research ought to tell him some things and allow some conclusions to be drawn: (1) why doesn’t any other state treat its uninsured this way, (2) why are Louisiana’s health care indicators around the bottom of the nation’s, (3) therefore, might not these two things be related, and (4) what makes Louisiana so different from all of the other states that it could not adopt their uninsured treatment policies and improve? Close behind in stupidity were the comments of another board member who insisted that, rather than Louisiana adopt policy of other states, that the rest of the nation could “learn from it and export it.”

Rather, this pair of dunces could learn from former Louisiana Health and Hospitals secretary David Hood’s analysis. Specifically referring to plans to build a new charity hospital to replace the present structure for Baton Rouge’s Earl K. Long facility before the hurricane disaster of 2005, Hood more generally demolished arguments to retain the charity system. He observes that time has passed the system by, how Louisiana spends more money for less quality care for its uninsured, and points out the biggest flaw, that the system has less than a dozen structures to which the uninsured statewide must travel to in order to receive care in that system, treatments which focus on the least efficient means, emergency room visits. (And, medical outcomes at the majority of those institutions lag those of nearby non-government hospitals.)

A more thoughtful objection comes from the systems’ chiefs who complain that the shift away of dollars might endanger medical education. That idea contains both a startling admission and a red herring. Note that it presumes medical provision at the charity hospitals is so poor and/or inconvenient (perhaps of great distances having to be traveled for some patients) that a significant number of dollars will be lost under the new plan. Also, it blindly assumes the way medical education presently occurs in the state does not itself bear fault for inefficiency in the system.

At the risk of being repetitive, why must this education be so decentralized? Most of the state’s medical interns serve at just a few of the hospitals. Why can’t programs be combined at just a few sites? And why must there by ridiculously inefficient situations such as two rural medicine programs 200 miles apart and two charity hospitals in the Florida Parishes almost down the road from each other?

Worst of all, the state in considering expanding the system, not only with a new hospital in Baton Rouge, but by rebuilding “Big Charity” in New Orleans. A number of informed individuals questioned the latter decision, arguing the existing facility could have been rebuilt – instead of building something entirely new in a region that already had too many hospital beds before losing almost a third of its population!

Defenders of the system simply cannot argue away these basic facts, yet they continue to try to salvage the system as is. Hopefully, the imperative of weaning the state off federal dollars in this area over the next few years will finally turn their attention away from vested interests of the system and towards creating a more efficient system to the benefit of both its consumers and state taxpayers.

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