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Levine leaves legacy of improvement, hope for more

The departure of Alan Levine as Secretary of Health and Hospitals provides a reminder to understand how the system has changed during his tenure, his contribution to it, and where it may and should go.

It’s not hyperbole at all to conceive of Levine as the second-most influential person in Louisiana during his two-and-half years on the job. Not many in the public realize that the single largest area of expenditure by the state, by far, is in the area of health care where well over a quarter of all state recurring spending annually from all revenues sources goes into it. The epicenter of any campaign to make Louisiana government more efficient because of this vast claim on dollars, Levine’s agenda, formulated from desires by his former boss Gov. Bobby Jindal (who formerly held the same job), that he was able to implement, has put the state on the road to much more efficient operation with at worst little reduction, if any, in quality of service.

Neither would it be exaggerated to conclude quality actually improved for many and helped the state as a whole. For example, the vast majority of individuals needing intermediate kinds of care – assistance with most life tasks because of disability or infirmity – are better off as a result of changes sought by Jindal and started by Levine. Efforts to steer people out of state-run institutions and into community settings or allowing them to receive services in the home not only improved the quality of life for clients, but also saved the state money.

The efforts also brought order to the system and rationality to use of taxpayer resources. Using the same area as an example, although the implementation wasn’t perfect – the Resource Access Model proved to be wanting and incompletely administered – the basic idea that service provision ought to be aligned with actual client needs took hold. The only lamentable aspect here was that it took tremendous fiscal stress to make this transition much less subject to political warfare than otherwise might have happened.

Some critics of Levine’s direction in reducing reimbursement levels really have more of a problem with the state’s disappointing money picture, where Levine had to make the best of a bad hand but got the flak as the decision that squeezed providers had to be made by him. Others were less honest in their motives from Levine’s attempt not so much to bring more privatization into the system but, more accurately, make it more responsive to market and client needs.

Defenders of state-run institutionalization as a strategy, while articulating nebulous if not irrational opposition to the state getting out of the direct provision of health care (if privatization is so bad, why is so often done in the area of health care), acted as such because they placed too high of a value on the electoral benefits of keeping things as they are, as it allowed them to claim they brought jobs to their districts and/or contracts to special interests, or ideology, through fervent belief that government ought to be as powerful as possible. All their blather ignores the fact that no state has a charity hospital system like Louisiana, some don’t have any state-operated resources and supports center (what were once called “developmental centers” in Louisiana), and many do not have state-owned nursing homes – and yet their health care outcomes in general clearly are superior to Louisiana’s.

In this area the greatest reform task lies – continued moving away from an institutional bias, whether by the state or in how it contracts out health care, in provision. For example, the charity hospital system must be whittled away to where there are just two state-owned institutions whose existence primarily is for medical education, most resources and supports centers must be closed, and nursing homes cannot retain the special, favorable treatment they get to the detriment of taxpayers, such as by the $23 million set aside last year for empty beds in nursing homes to make up for their own foolish investment decisions.

Levine would have been a great ally in this campaign and it is hoped his successors prove as effective as he did. He leaves the state’s health care system much better off than when he inherited it.

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