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Use Edwards' hospital cut request to exit charity model

Building on yesterday’s post, can liberal Democrat Gov. John Bel Edwards also become the one who finally frees Louisiana from any vestiges of its archaic charity hospital system?

Until a few years ago, Louisiana insisted on continuing its outdated model where anybody could walk into what then comprised a system of ten hospitals, mostly in urban areas, and receive free treatment for whatever ailed them, regardless of severity. That system delivered subpar medicine, in no small part because, as the laws of human behavior dictate, make something free and people engage in overconsumption of it. This produced queued care as hospitals became treated like primary care centers and for any ailment, no matter how minor or even fictional, squeezing out the more serious cases and promoting wasteful resource use.

Unfortunately, way too many policy-makers preferred this inefficient use of taxpayer dollars because it provided superior symbolism, if inferior service delivery, of some asserted commitment to the “poor,” and also because this could act as a patronage sink and job machine that politicians in these areas could crow about to secure reelection. So it took another misfortune, Congressional repeal of a law that favored Louisiana’s Medicaid funding (ironically because of the economic bump resulting from the heavy influx of federal aid from the hurricane disasters of 2005) to shock them out of their complacency, and former Gov. Bobby Jindal wisely used this leverage to exit halfway the system.


Legislature should run with Edwards' TOPS budget

Is liberal Democrat Gov. John Bel Edwards the guy conservatives have been waiting for, at least as far as reform of the Taylor Opportunity Programs for Students?

Last week, the Edwards Administration announced that for fiscal year 2017 Edwards would budget the program that pays full tuition for students with mediocre-and-above credentials at only about 20 percent of its predicted demand, using only funding dedicated to it. It forecast that would mean that instead of an American College Test score of 20 to qualify, the standard would go as high as 28. This would occur unless a combination of cuts elsewhere and tax hikes freed up money, with the more pledged the lower the ACT cutoff score until it reached the legal minimum of 21.

To which those who care about efficient use of taxpayer dollars and rewarding quality should respond, “Please, can we?” TOPS, with its four-ninths dropout rate as a consequence of allowing marginal achievers to capture free tuition to attend a state university (guaranteed admission as the TOPS standards exceed entrance requirements for most state universities), acts much more like an entitlement program than a true scholarship program and thereby carries the same ills: it discourages more than marginal achievement, 40 percent or more of it gets wasted, and it forces taxpayers to subsidize a number of indifferent students who might better serve society and themselves through not attempting collegiate work. Even worse, unlike most entitlement programs, its fa├žade of merit standards – so low they hardly meet the definition – ends up having taxpayers subsidize higher-income families, who defend it by saying they pay enough in taxes and ought to have at least one program that directly benefits them.


Edwards' budget promotes ideology over real solutions

Rather than construct a budget putting Louisiana first, Democrat Gov. John Bel Edwards built the executive fiscal year 2017 document based on pursuit of liberal ideological imperatives.

His strategy of no pain, no gain – in other words, he cannot gain expansion of government without dishing out as much pain as possible to frighten people and their representatives into tax increases to fund a bigger state – calls for some roughly standstill spending for some parts of government and bigger drops in others, with the notable exception of a huge increase in health spending, most notably on Medicaid given his decision to expand it.

That alone actually boosts the budget much higher than the amended FY 2016 version currently limping along by over $1.5 billion higher to reach over $26.5 billion total. While a good chunk of that comes from increased federal funding that raises the amount of national debt each Louisianan owes, forecast at $2.2 billion more, some of it also comes from the state. A 2013 study, now understood to underestimate actual costs to the state, including administrative costs already consented to by the Edwards Administration not part of the research, forecasts net change for FY 2017 caused by Medicaid expansion to cost $41 million extra.