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LA needs federal prodding to do right health care thing

And another way Louisiana is behind the curve is in its continued resistance to revamping health care in a way that maximizes outcomes for reduced cost. Of course, missing the deadline to institute changes for 2007 in health care delivery is also partly due to the legendary inefficiency in Louisiana’s government getting services provided (such as Gov. Kathleen Blanco’s choice of administrators of the Road Home Progam), but the lion’s share of blame rests with the politics-as-usual emphasis by its politicians.

“Politics-as-usual” in the case of health care delivery in Louisiana means an overemphasis and bias on institutional- rather than community- or individual-based health care solutions. This is why the state’s health care redesign effort continues to try to force feed a questionable “medical home” plan that shovels money first to institutions rather than a “money-follows-the-person” model that shifts it to the individual or his representatives that other states have been adopting.

Two factors explain why Louisiana remains so obstinate. First, there is the inertia of the ultimate institutional model of health care, the charity hospital system that only Louisiana insists on having. Despite generally worse outcomes from it, because of the hundreds of millions of dollars spent on it and the tens of thousands of jobs tied into it, those that have a finger in this pie and the politicians they have courted to support it continue to defend it and thus resist dismantling it.

Second, politicians themselves have acquired vested interests in it to further their own careers, both inside and outside of politics. You need look no further than the top-ranking state senators on its Health and Welfare Committee. Chairman Joe McPherson operates nursing homes and with Vice Chairwoman Sherri Smith Cheek who gets a major portion of her campaign funding from the health care industry have helped push through laws that increase rather than decrease the institutional bias that causes the inefficient expenditure of taxpayer resources.

McPherson plans to introduce legislation in the regular session that will continue the suboptimal, wasteful institutional bias. The excuse he uses is the red herring resisters to true redesign often proffer, that costs will go up with it. They are correct in that in the short term expenses will, representing the cost of maintaining two systems in transition. But in the long run, costs per successful outcome will go down because of efficiency savings.

The federal government had indicated it would pay a large portion of these transition costs, but that has wavered with the accounting for of huge budget surpluses in the state, which the resisters like McPherson have tried to use to forestall true redesign. But it is only right that the state pay some increased share if it is able; ironically, the surplus almost exclusively has been produced by the ten of billions of dollars of federal money being pumped into Louisiana in disaster recovery efforts, yet the state wants more and more.

Once again, it looks like the federal government is going to have to force clueless policy-makers in Louisiana to do the right thing. It should tell the state it will expect no waivers or additional funding whatsoever unless the money-follows-the-person-model is the primary basis of any redesign. Meanwhile, distractions from implementing this model only have served, and will continue to serve, to delay and deny the best health care that Louisianans should enjoy.

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