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Stuck on stupid XX: Blanco instransigence may cost LA

One important reason why Louisiana has fallen behind the rest of the national on quality of life indicators is because its good-old-girl style of governance places greater importance on protecting favored constituencies than in creating more efficient government that uses resources more wisely. Its current position on health insurance for the indigent provides a perfect example of Louisiana wanting to do the same old thing – and how that may cost the state a chance at hundreds of millions of dollars as a result.

In order to garner funds from the federal government, with a deadline of Oct. 20, the state must demonstrate how it has “redesigned” health care in the state. This particularly is an issue given the damaged health care infrastructure in New Orleans, and decisions about rebuilding and building new hospitals in the charity hospital system. Louisiana is the only state that covers health insurance for the indigent through provision by state-run hospitals.

Federal Secretary of Health and Human Services Mike Leavitt has been insistent that the state use the model the federal government and remainder of the country has been moving towards steadily, “money follows the patient.” It has been demonstrated to produce better and more efficient outcomes by increased and more flexible choices for treatment, instead of the “warehousing” system used by Louisiana that forced care into the less-efficient public sector and made for “one-size-fits-all” solutions that do not emphasis prevention or optimal, individualized patient care.

The state bleats that it has to keep some form of the charity hospital system (which will cost hundreds of millions of dollars just to rebuild) prominently as part of a redesign because it’s otherwise too expensive. This is because this arrangement allows the state to suck in Medicaid dollars it otherwise would not get because the charity system is so heavily invested in indigent care, despite its gross inefficiency, while shifting focus would not save as many dollars retained by the state as it would have gotten through Medicaid, estimated to be extra to the state $231 million a year at first, coming down to $155 million thereafter.

As a result, Democrat Gov. Kathleen Blanco, state Secretary of Health and Hospitals Fred Cerise, and many of the panel she created to study the matter continue not only to resist this idea; rather, they wish to use coercion to force people to pay into the system. Their redesign model does not exit the state from the charity hospital business; indeed, their idea of revamping includes mandating middle-class parents to pay for insurance for their children and forcing health care costs onto small businesses and the voluntarily uninsured who can pay.

Even the state’s cries about being to poor to afford money-follows-patient revamping ring entirely hollow. Only a couple of years ago the state’s own Legislative Auditor found a simple restructuring of reimbursement rules could save the state nearly $100 million a year, away from rules that favored high-cost warehousing of the elderly and disabled in nursing homes instead of more efficient community-based care. Instead, this spring the state took the rules that created this favoritism and embedded them into law.

But an even bigger sacred cow than nursing homes is being saved here, and explains the actions of Blanco and her cronies – the charity hospital system. As one (maverick) member of the redesign panel noted, the real conflict on the panel involves the future of the charity system; until the state resolves to rid itself of the system (by selling off, if possible, most of its hospitals and retaining only the teaching institutions), Blanco will continue to fight the will of the federal government and the better ideas it has in this area (just as she did with the superior ideas it had for structuring the state’s recovery from the 2005 hurricane disasters).

Especially mind-boggling is that an excellent plan already exists, in a modified (admittedly for the worse) fashion already proving its worth in Massachusetts, recommended by the Louisiana State Medical Society and acceptable to the federal government. But Blanco and her minions refuse to accept any form of it, hiding their protection of big government’s involvement in health care through buzzwords like trying to have a “responsible” plan.

Once again, many of Louisiana’s leaders remain stuck on stupid, wanting to keep an existing system in power, wanting to keep doing business as usual, not because it’s the right thing to do, but it brought them power and privilege. And, yet again, it looks as if the federal government will have to practice tough love to move the state forward. The remaining question is just how stubborn is Blanco willing to be to fight to save the good-old-girl network’s interest on this issue, and how much it will cost Louisianans as a result.

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