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Instead of blaming, Blanco needs real redesigning

It’s been a recurring theme of Gov. Kathleen Blanco’s tenure in office – blame somebody or something else for the deficiencies of herself or her administration. She parades this again when it comes to the “redesign” of Louisiana’s post-disaster health care system.

We’ve seen it on reconstructing the state. We’ve seen it on housing rebuilding. Now we get an eyeful of Blanco complaining about how the federal government gives her “mixed signals” on the restructuring of state health care, beginning with New Orleans.

But the only way that perception has any credibility is if the federal government failed to communicate to Blanco, state Health and Hospitals Secretary Fred Cerise, and (some, but not all of the members of) her panel created to study the issue using the English language. Reading news accounts over the past month their message is clear and, as a public service to Blanco just in case she has trouble with English, I will spell it out for her as I understand it, just from media reports:

No redesign will create a two-tiered health care delivery system for the uninsured (period, end of message). Yet Blanco has persisted in continuing to build a plan which does exactly that. In fact, she wants to build a whole hospital to be a part of the charity hospital system that is the backbone of the two-tiered system, to replace the rebuilding facility in New Orleans. The intent is to have this as a collaborative effort with the Department of Veterans’ Affairs and to create a brand-new teaching facility.

One must question the sinking of any dollars into new facilities not only because the greater New Orleans metropolitan area is down nearly one-third in population with that unlikely to change any time soon, but also because the area already had surplus hospital capacity prior to the 2005 hurricane disasters. A new facility, despite Blanco’s public utterances, is part and parcel of the two-tiered plan, called that because it would allow Louisiana to justify continuing to operate public hospitals, unique among the states.

Elsewhere I have explained why politically Blanco refuses to let go of this plan, because institutionalized bias in medical care in Louisiana is a sacred cow. But she continues to try to support it by saying the money-follows-the person plan would cost more money.

Yet the state’s own auditor has shown that the institutionalization bias just in Medicaid reimbursement in nursing homes costs taxpayers nearly $100 million extra. The reason why the federal government’s plan on the surface would appear to cost more money is that the state would insist on keeping its charity hospitals open, instead of closing or selling most of them. Only in Louisiana are public hospitals considered primarily there for public health reasons; all other states primarily use them for advanced medical training.

If Louisiana adopted that model, it could remove most of the 11 charity hospitals from state ownership; most of those would be bought by the private or nonprofit sector and the truly inefficient/underutilized ones would close. That, of course, would mean realigning advanced medical education in the state, consolidating as do other states around three or four hospitals. No other state has such dispersed, duplicative medical education as does Louisiana. For example, why have two rural medicine programs in Lake Charles and Bogalusa (the latter started just a couple of years ago)? Why not consolidate at one location?

The reason, of course, was to justify the existence of so many public hospitals. By keeping so many of them around, the state can claim the money-follows-the-person plan placed on top of them would create more spending. But this system has created tremendous inefficiencies in the delivery of health care for the uninsured. This is why the federal government insists so strenuously on prohibiting a two-tiered system: it does not want to support this inefficiency with its health care dollars (most health care provided by the state is paid for by this money). And that is clearly a responsible thing to do on behalf of Louisiana and U.S. taxpayers.

(And if Blanco, Cerise, or hospital system chief Don Smithburg complains such reform won’t work, ask them a simple question: why, when no other state does, must Louisiana have a charity hospital system? Even states just as poor as Louisiana do not and have better medical outcomes. Why must Louisiana be so different? They’ll be unable to give you a straight, sensible answer to these and they probably won’t even try.)

But to hide her true agenda, Blanco now takes to blaming somebody else. It’s a tiresome act which hopefully won’t have to be endured any more starting in 2008. But in the interim, she and her cohorts needs to get with the program (due date for an initial draft is Oct. 20) and then plan to pay for it by changing the entire philosophy behind the charity hospital system. Only this real redesign will improve health care delivery in Louisiana.

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