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Time running out for more efficient LA health care delivery

Once again, Louisiana is letting special-interest-driven politics put it into position to lose opportunities and to create waste and inefficiency with taxpayers’ dollars, this time over the specific issue of a veterans’ hospital site in New Orleans.

Ever since the Medical Center of Louisiana New Orleans (“Big Charity”) got substantially damaged by Hurricane Katrina in 2005, plans have circulated to rebuild it near the Central Business District in tandem with a new Veterans Administration hospital, where certain non-medical facilities would be shared reducing both building and operating expenses.

The federal government has long wanted to move forward on the project. But the cooperation necessary from Louisiana had been disrupted by the state’s inability to decide how a new Big Charity would fit into the larger, overall picture of indigent health care in the state. The federal government strongly has urged the state to abandon its two-tiered, money-goes-to-the-institution system (the only state in the Union that has such a system) and instead head in the direction all other states, richer and poorer, are going to a money-follows-the-person regime, given the greater efficiency and higher outcomes the state likely is to realize as a result.

Since such a move would remove power and privilege from key politicians, other officials, and some health care institutions, the state has resisted and the size of the new Big Charity has become a pawn in this larger battle. The most recent, aggressive move by the state to block real reform is to sponsor a report that argues the new Big Charity should be about twice the size that advocates of genuine redesign envision. The larger the new hospital is, the less expensive the current faltering system around which the state wants redesign to be seems compared to the necessary reconfiguration proposed by the federal government and supported by various other politicians and health care advocates.

No doubt this has irked the federal government, its patience already thin by an unnecessary protracted struggle, so last week it lowered the boon on the state by announcing it actively had been shopping around for alternative sites that would not pair up the new Big Charity with the new veterans’ facility. This led the state and city to scramble madly to prevent their agreement’s scuttling, as removing the synergy would push up the building costs tens, maybe hundreds of millions of dollars and would make a larger facility even less efficient in operations.

In October of last year the state, somewhat late, finally coughed up its redesign plan which did not substantively change delivery of indigent health care in the state. Had it removed vested interests from the equation and accepted real reform, probably by now the shovels already would be turning dirt for building the new hospitals with Louisiana’s part maybe half of the cost of the large facility it now tries to foist on taxpayers, with the promise of better health care provided more efficiently in the not-distant future, at great savings eventually to taxpayers.

Instead, the obstinacy of state leaders continues unabated, and even this latest prodding by the federal government may not get it to changes its counterproductive approach – just so typical of Louisiana government in action.

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