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Stuck on stupid XXII: Saving big government rather than money

If an idea makes sense, you can bet the good-old-boys (and girls) that comprise a majority of elected officials in Louisiana are going to reject it. Gov. Kathleen Blanco in this regard didn’t disappoint when she said a universal health care plan whose early indications in other states are positive that would replace Louisiana’s solitary, inefficient, and low-performing charity hospital-based plan “seems to be an insult to our intelligence.”

Blanco and her minions continue to insist that the plan pushed by the federal government, which states across the country are adopting, is not for Louisiana. Alone among analysts of the plan, which would steer federal health care dollars away from institutions and into the hands of presently-uninsured health care clients, they actually think, when all the evidence is against them, that only a system something like what the state presently has will produce cost-effective and acceptable patient outcomes.

One reason Blanco has taken this line is that the federal government has not offered to pay for all of the transition costs into the better system. There will be some because for awhile two systems, the recommended money-follows-the-person and the existing money-given-to-the-institution, will run simultaneously. As time passes and the former, efficient system gains usage at the expense of the latter, inefficient one, costs per uninsured will decrease.

As usual, Louisiana wants somebody else to pay for its mistakes, even as the state sits on potentially more than a billion dollars in surplus that could pay for any transition dollars the federal government does not provide – which would provide savings in the future. But the state’s contention itself rings hollow that the costs will be so high. Both the federal government and those outside government repeatedly have questioned this state’s figures, saying they are very much exaggerated.

Even if the state’s claim wasn’t so dubious, the fact remains many savings could be made in Louisiana health care spending with simple legal and procedural changes. Just to name one, the state’s own auditors concluded that nearly $100 million a year alone could be saved by changes in how nursing homes are reimbursed.

Another indicator of the state’s inherent inefficiency in providing care is in its per capita expenses for uninsured care. In Massachusetts (which recently reformed its system along the lines Louisiana should), that state spent about $1.3 billion last year for a population of almost 6.5 million, or an average of $202 per person, while Louisiana spent $935 million for a population of just over 4.25 million for an average cost of $218 per person – and Massachusetts covers more services and more expensive ones than does Louisiana. A money follows-the-person system would force more efficiency into spending as private entities who must compete against each other take a bigger share of total dollars spent.

The smokescreen about costs gets circulated because the Blanco Administration needs political cover for its real motive in rejecting needed change: protecting the large state government structure of charity hospitals and other institutions, and interests of other institutions outside of government who have become junkies dependent upon state money in this policy area. Tossing money around to certain constituencies brought these people to power, and it’s the only thing they know.

It’s the old unwelcome love of big government exhibited by Blanco and many of her predecessors and fellow state politicians who do not really understand the way the world really works and who put more faith in government than in people to solve problems. And thus she and defenders of the present ailing system, like state Sen. and nursing home operator Joe McPherson, on this issue remain stuck on stupid.

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