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Thanksgiving Day, 2008

This column publishes usually every Sunday through Thursday after noon (sometimes even before; maybe even after sundown on busy days) U.S. Central Time except whenever a significant national holiday falls on the Monday through Friday associated with the otherwise-usual publication on the previous day (unless it is Independence Day or Christmas or New Year's when it is the day on which the holiday is observed by the U.S. government). In my opinion, there are six of these: New Year's Day, Memorial Day, Independence Day, Veterans' Day, Thanksgiving Day, and Christmas.

With Thursday, Nov. 27 being Thanksgiving Day, I invite you to explore the link above.


New Big Charity coming, but likely in delayed fashion

Yesterday I referred to the final site selection for the new Medical Center of Louisiana – New Orleans as a “minor victory” for the state, because while it had gotten a commitment from the federal government to provide the money-saving option of intertwining it with a new Veterans’ Administration hospital, controversial work remains to be done that could delay the opening of the advertised state-of-the-art facility past its scheduled opening date of 2013 – perhaps way past then.

First, there’s the matter of the historical structures located in the district, bordered by Canal, S. Claiborne, Tulane, and S. Rocheblave. Only as an extreme last resort could these be molested, so either they must be incorporated into the new facilities and/or campus, or moved. But there are nearly 200 such structures and only $400,000 budgeted for removal, at just $20,000 each. If preservationists and owners are successful in getting, by government acquiescence or judicial fiat, more money to move more things, costs could skyrocket and slow the building down tremendously.

(As practical matters go, the Deutsches Haus should be built around and allowed to operate unmolested, even subsidized, as long as the medical staff frequent it only on their off hours and well before their next shift begins. Better than sending them across the way to the unpredictability of a reconstituted Nick’s Bar, where, if the campus is planned right, parking might actually improve. Most importantly, if done right, parking for the Canal Street parades could improve as well and the city could make a little money from those tired of driving all around Mid-City hours before a parade to find a parking spot leaving an inch of space on both end and a 1 percent chance either it’ll get sideswiped or washed by desperate paradegoers).


Jindal needs to do what it takes to reform health care

The most important thing that Louisiana can do as it stares down a large budget deficit is to reform its provision of indigent health care. While some prepare to address that, others want a continuance of the old ways that threaten the state’s very fiscal health.

Let’s review representative spokesmen in this policy struggle. Department of Health and Hospitals Secretary Alan Levine has argued that in 2009 the Legislature needs to clarify the legislation passed under Democrat dominance in the Legislature and pushed by Democrat former Gov. Kathleen Blanco that tinkered with the existing system. That basically put the state on the hook to pay whatever it was billed that appeared to conform to law, with no real effort to induce efficiency into the system, but, because the state is so involved in health care by direct provision of it through its outmoded charity hospital system, it didn’t really care since the federal government would pay for so much.

The problem is, to a lesser extent the state must match these payments and as Levine as made clear current rates of consumption are unsustainable. The 2007 legislation created a “medical home” concept that would assign the indigent to facilities (many state-run) but that would continue a fee-for-service billing. Levine and his boss Republican Gov. Bobby Jindal did an end run around that introducing a coordinated care regime that would allow only indirect billing by providers by routing everything through administrators of insurance-like plans, who because they must report to shareholders of some kind would have far more incentives to hold down costs, thus potential revenues to the providers. House Speaker Jim Tucker appears sympathetic with his desire to have his members meet with the apparent agenda of selling this idea.

Carrying the water for the current vested interests in the existing system is Democrat state Sen. Joe McPherson, who has interests in nursing homes which make the vast majority of their money off of government. Under the planned regime it would force more efficiency onto institutional providers meaning they must improve their performances and probably would steer business away from them to more community-based solutions. This they do not want because it means more work and fewer revenues. McPherson and his gang want less specificity in the law because then it gives them more freedom to reject what Jindal wants to do and to force their own, static “solution” onto the problem which would not be close to what is needed to improve care and control costs.

But Jindal, if he has resolve, has the upper hand in this contest precisely because of the looming budget shortfall. With a Republican House he probably can expect approval there of legislation steering the state onto the coordinated care track. The Senate, where McPherson plants himself, with 24 of 39 senators being Democrats is another matter. In normal times, it might be tough to move enough Democrats onto Jindal’s side. However, the huge deficit permits Jindal the chance to identify and make severe cuts to programs favored by potential opponents of the overhaul, with the perfectly legitimate rationale of the big deficit, with the ultimate weapon of a line item veto. Enough of those threats, and the nattering nabobs of negativity like McPherson will be cornered into submission.

Today was announced a minor victory for the state, the rebuilding of the Medical Center of Louisiana – New Orleans hospital (“Big Charity”) in tandem with a Veterans Administration hospital that will bring significant cost savings to the state (the proposed structure still might be a little grandiose for state needs and taxpayers’ sufferance, but it seems better than the original Blanco plan that favored the continued inefficient institutional focus of the state’s health care). Hopefully, Jindal will continue on this tack and do what is necessary to get the single most important reform to state policy into law as quickly as possible.


Dynamics give Cao unusual chance to win the Second

Given that Democrat Rep. Bill Jefferson has a tremendous legal cloud over him and the presence of the inspiring story of his challenger Republican attorney Anh “Joseph” Cao in the contest for the Second District Dec. 6, does Vietnamese Cao have a chance to defeat black Jefferson even in a district where half the registered voters are black Democrats, Republicans make up only a little over 11 percent of the electorate, and only a minority of the roughly 7.5 percent that comprise “other” race voters are Vietnamese?

Actually, if you go by the numbers, yes. We must recall that in the upcoming election that now Republicans will be able to vote, and few if any will vote for Jefferson, and that some substantial portion of the vote for his runoff opponent was an anti-Jefferson vote that could transfer to Cao in the general election.

Most Republicans are white, and the statistics show that blacks outnumbered whites nearly 3:1 in the primary, but only 2:1 in the total electorate. Further, Jefferson did experience some slippage among blacks in that primary vote. Looking at precincts (about 20 percent of the total) that were at least 90 percent black and less than 2.5 percent white, the Jefferson vote on average was 10.5 points less than the percentage of blacks minus the percentages of other races and of white, meaning only about 90 percent of blacks voted for Jefferson.

That noted, whether these race defectors would support an Asian Republican is another matter, but surely there are some that would as some of these district showed much lower supports rates for Jefferson, some only supporting him in the mid-60s range. More intriguing is the question whether the other race population will defect in much larger numbers. Analyzing the relationship between race and vote, while black percentage registration almost perfectly correlated to vote for Jefferson (positively, while about the same high statistics was noted for white percentage registration but negatively), the statistic for other races was a bout half as power and also negatively related to Jefferson vote proportion. This suggests a much more even splitting of the vote among these voters.

More intriguingly, Jefferson seemed to gain little white support in the runoff. Only about 4 percent of all precincts had at least 80 percent white and no more than 5 percent black populations, but of those, the Jefferson vote on average was only 5 percent more than the black population in the district. Again, partisanship may make some whites support Jefferson against Cao, but this suggests that, reversing the typical pattern, there could be more defection among blacks from Jefferson than willingness to support him among whites.

Finally, turnout must be considered, which overall counting a vote for any office was a little over 54 percent, varying depending upon race and partisanship. Relevant here is that it was about 60 percent for white Democrats, 59 percent for Republicans, 57 percent for black Democrats, and 45 percent for other race voters. Therefore, we can run a model using these turnout figures and assuming Jefferson gets 5 percent of the white vote and 90 percent of the black vote, Cao gets the reverse but all Republican votes, and they split anyone else left over.

The overwhelming black Democrat advantage would give Jefferson the advantage at about 60 percent, whereas in the primary he won with only 56 percent. Since Cao is getting all the Republicans, it should be closer but what this demonstrates is that Jefferson did worse in the runoff in the higher-turnout districts which tend to be more affluent. This is what gives Cao a chance.

Two years ago when the last runoff in December was held for the district, turnout was miserably below 20 percent. If lower-income blacks disproportionately do not turn out relative to whites, Republicans, and higher-income blacks, that recipe may fall right for Cao. By the numbers, if black Democrats fall to their 2006 level of turnout, about 14 percent, while the others double their historical rates to about 30 percent, Cao gets a majority of about 4,000 out of 52,000. This would be 10,000 fewer votes than in 2006, however, and of that extra 10,000 Jefferson probably would get most. Yet if Cao gets better than half of other race voters (the least likely to turn out), any lower turnout among non-black Democrats could be offset.

This is a longshot. Still, the unusual dynamics witnessed in the Democrat runoff, no doubt a product of Jefferson’s tainted status, is what gives the GOP any chance at all to grab this seat.