Carnival ended over a month ago, but the message didn’t get through to Gov. Kathleen Blanco, whose 2007-08 budget showers the state with all sorts of additional spending with an eye towards trying to secure reelection – and thus threatens to throw the state into future fiscal crisis.
Economic observers long ago reached a consensus that unexpectedly high state revenues now experienced by Louisiana came as a result of a burgeoning false economy, fueled by federal reconstruction dollars that would halt by the end of the decade. Prudent voices called for returning a surplus now streaking past $3 billion to the people, to allow for greater individual investment that would boost economic development so that when the extra money stopping coming into the state, an improved private sector capacity could keep revenues higher.
But prudence or wisdom never have been the hallmarks of Democrat Blanco and the Democrat Legislature’s fiscal policies since they see government spending as a tool to buy votes to keep themselves in power. Blanco’s budget contains relatively little tax savings and instead commits the vast bulk of the expected surplus that can be spent on recurring items on such expenses, making commitments that the state unlikely can keep in future years without creating fiscal turmoil.
Not only does Blanco ignore reality in this budget, she demonstrates once again she would rather empower government than people. Her plans call for hiring another thousand people into a state bureaucracy already bloated. She also commits more money to the inefficient, ineffective institution-based indigent care system focusing on state-owned charity hospitals rather than redesigning the system in favor of a money-follows-the-person regime that will save money in the long run.
Unfortunately, Blanco has the votes to push through this incumbent-protection budget in the Legislature, but with a catch – the state spending cap which thwarted another free-spending attempt of hers last December. Here, Republicans if they stick together can stop at least some of this, since they have more than a third of the House membership and a two-thirds vote is required to bust the cap. Yet, this issue also may be one where Blanco will muscle through a triumph of politics over principle.
Because the state’s economic growth has been so poor, the cap grows slowly. But, as it turns out, in order to create more room for spending, actually the administration uses a less reliable computation to inflate the total. Depending how this number comes out, that could allow Blanco much more leeway to spend all outdoors despite GOP recalcitrance to allow this.
Blanco’s budget provides yet another example of how she and the rest of the politics-as-usual crowd that have made Louisiana last among all the states on so many quality-of-life indicators remain stuck on stupid.
15.3.07
Why is Landrieu invested in America's defeat in Iraq?
The U.S. Senate defeated a measure that would have mandated withdrawal of troops from Iraq by the end of August, 2008. Aside from the questionable constitutionality of this measure, voting on the measure tells us what various members of the Senate believe.
Note that Democrat Sen. Mary Landrieu voted in favor of this. By doing so, Landrieu signals to Louisiana voters that she believes in the following:
That the overwhelming economic power, superior training and abilities, and will of the American military backed by its people and politicians cannot defeat irregular forces haphazardly reinforced and supplied by America’s enemies
That democracy is not worth saving in Iraq, where the establishment of a stable democracy will present a model for the Arab world that they do not have to live under despots ranging from benevolent to virulent, the establishment of which will encourage the mutation of regimes varying from cautious cooperative to outright inimical to U.S. interests to those with common cause with America
That she is willing to tolerate, by increasing the chances that the current Iraqi government will not survive by a withdrawal of U.S. military forces its dismantling and radicalization into a regime hostile to the U.S. and Western values of democracy, moderation, tolerance, freedom and equality that will prove as great a threat, and probably greater, to America than under its previous authoritarian system
Landrieu either does not understand or has no desire to comprehend that setting a timetable for withdrawal signals to the opposition that the U.S. lacks the will to carry out a vital act of increasing its own security and self-preservation. Anything short of withdrawal only when U.S. interests are secure – and only the ignorant or disingenuous do not admit America fully has the means to insure this if it wants to – concedes defeat and leaves the U.S. in a worse position than it was years ago.
What Landrieu’s opponents in 2008 must ask her during her reelection campaign is whether she is just stupid, or why does she want America to lose the war and make Louisianans less secure? If the latter, why does she invest herself in defeat of America? What is it about America, and Louisiana, that she finds so appalling that she wants to see her own country harmed? These questions deserve a response from her.
Note that Democrat Sen. Mary Landrieu voted in favor of this. By doing so, Landrieu signals to Louisiana voters that she believes in the following:
Landrieu either does not understand or has no desire to comprehend that setting a timetable for withdrawal signals to the opposition that the U.S. lacks the will to carry out a vital act of increasing its own security and self-preservation. Anything short of withdrawal only when U.S. interests are secure – and only the ignorant or disingenuous do not admit America fully has the means to insure this if it wants to – concedes defeat and leaves the U.S. in a worse position than it was years ago.
What Landrieu’s opponents in 2008 must ask her during her reelection campaign is whether she is just stupid, or why does she want America to lose the war and make Louisianans less secure? If the latter, why does she invest herself in defeat of America? What is it about America, and Louisiana, that she finds so appalling that she wants to see her own country harmed? These questions deserve a response from her.
14.3.07
Previously against, now Landrieu favors majority rule
Democrat Sen. Mary Landrieu’s career to date has been an exercise in trying to get enough voters to think of her something that she is not – concerned with empowering people, instead of giving the people short shrift in favor of assisting special interests through big government. Usefully, she occasionally reminds us of this as with remarks she made about hurricane disaster-related legislation recently passed in the Senate.
Landrieu was disappointed because the bill does not waive in total the 10 percent match (reduced by Pres. George W. Bush from the legally-required 25 percent) the state must pay on receiving a small portion, less than seven percent, of the total funds sent to the state for disaster relief (the remainder has no matching requirement). This complaint does ignore the fact that federal monies have already boosted state tax receipts by several times that non-waived amount, helping the state to a surplus now believed to be $3.2 billion.
Her remarks on the subject rather address that several senators (apparently Republicans) put “holds” on the parts of the bill that would have waived the matching requirement entirely. She decried “some senators blocking so much as an up-or-down vote on these measures” and said that “Such tactics are shameful, and are not what the American people elected us to come here to do.”
This being her view on the matter, it appears Landrieu has called out herself. A couple of years ago, she was a senator who was not permitting “up-or-down” votes on some of Bush’s nominees to the federal courts, instead hiding behind procedural votes with most other Democrats. (Her refusal in one case was a direct repudiation of a campaign promise.) Eventually, she joined a movement to subvert the idea of up-or-down votes on several nominees, along with 13 other senators, that had the effect of scuttling Bush nominees without ever getting such a vote.
This is the Landrieu way. Consistently she has fought for greater control of government over people’s lives to aid her allies and special interests – on this past issue, preventing acceptance of some well-qualified nominees despite their support by a majority of senators elected by a majority of the people because of opposition by these special interests. But concerning the present issue she suddenly becomes a supporter of the up-or-down principle – because it’s one she think will curry favor for a reelection bid, trying again to fool Louisianans.
Thus, seemingly inconsistent behavior on Landrieu’s part really isn’t, when one understands that Landrieu runs a constant con game on the Louisiana public, because for her it’s not about governing by principles to empower people, but about the acquisition of power and privilege to rule over them – and there’s the main principle around which she has organized her political career.
Landrieu was disappointed because the bill does not waive in total the 10 percent match (reduced by Pres. George W. Bush from the legally-required 25 percent) the state must pay on receiving a small portion, less than seven percent, of the total funds sent to the state for disaster relief (the remainder has no matching requirement). This complaint does ignore the fact that federal monies have already boosted state tax receipts by several times that non-waived amount, helping the state to a surplus now believed to be $3.2 billion.
Her remarks on the subject rather address that several senators (apparently Republicans) put “holds” on the parts of the bill that would have waived the matching requirement entirely. She decried “some senators blocking so much as an up-or-down vote on these measures” and said that “Such tactics are shameful, and are not what the American people elected us to come here to do.”
This being her view on the matter, it appears Landrieu has called out herself. A couple of years ago, she was a senator who was not permitting “up-or-down” votes on some of Bush’s nominees to the federal courts, instead hiding behind procedural votes with most other Democrats. (Her refusal in one case was a direct repudiation of a campaign promise.) Eventually, she joined a movement to subvert the idea of up-or-down votes on several nominees, along with 13 other senators, that had the effect of scuttling Bush nominees without ever getting such a vote.
This is the Landrieu way. Consistently she has fought for greater control of government over people’s lives to aid her allies and special interests – on this past issue, preventing acceptance of some well-qualified nominees despite their support by a majority of senators elected by a majority of the people because of opposition by these special interests. But concerning the present issue she suddenly becomes a supporter of the up-or-down principle – because it’s one she think will curry favor for a reelection bid, trying again to fool Louisianans.
Thus, seemingly inconsistent behavior on Landrieu’s part really isn’t, when one understands that Landrieu runs a constant con game on the Louisiana public, because for her it’s not about governing by principles to empower people, but about the acquisition of power and privilege to rule over them – and there’s the main principle around which she has organized her political career.
13.3.07
Vitter's unsual bedfellow strategy carries low risk, high gain
To get as far as Sen. David Vitter has in the political world, one has to have good political instincts and be willing to take risks. In his decision to endorse former New York City Mayor Rudy Giuliani for the Republican nomination, Vitter relies on both qualities.
With decidedly non-conservative views on social issue such as abortion, single-sex marriage, and on gun control, Giuliani would not appear to mesh well with Vitter who would oppose Giuliani on all three, as would the majority of Vitter’s Louisiana constituents. Nevertheless, Giuliani and Vitter do see eye-to-eye on most other parts of the conservative agenda.
It’s clear a deal has been made, with Vitter’s nod being a source of comfort to conservatives uneasy with Giuliani’s strays from the ideological fold, while Vitter would gain great prominence under any Giuliani Administration for helping him at a crucial time. His appointment as a major campaign operative of Giuliani’s points to this. And, when analyzed, it’s not exactly a big risk for Vitter.
If the frontrunner Giuliani doesn’t end up grabbing the nomination, in contrast to the last several Republican presidential derbies, Vitter may lose a little luster back home, but not nearly enough to invite a conservative challenge nor really to empower any liberal opponent. Absent major mistakes, Vitter seems set for a long run as one of the state’s senators, affording him the chance to get out in front of a candidacy most conservatives, even those primarily interested in social issues, would have to support. The two most likely Democrat nominees, Sens. Hillary Clinton and Barack Obama, are among the most liberal in the body, especially on social issues. Few social conservatives could stand by and be complicit through non-participation in allowing such antithetical candidates the chance to get in the White House by deferring even lukewarm support for Giuliani.
By 2010, when Vitter must run for reelection, either a misstep will be forgotten largely, or his enhanced stature will make him more powerful – and potentially more helpful for Louisiana’s interests – than ever. While this isn’t exactly a case of politics making for strange bedfellows, it’s at least an instance of unusual ones. But, politically, it is a low-risk move for Vitter that may pay off substantially in terms of both electability and power.
With decidedly non-conservative views on social issue such as abortion, single-sex marriage, and on gun control, Giuliani would not appear to mesh well with Vitter who would oppose Giuliani on all three, as would the majority of Vitter’s Louisiana constituents. Nevertheless, Giuliani and Vitter do see eye-to-eye on most other parts of the conservative agenda.
It’s clear a deal has been made, with Vitter’s nod being a source of comfort to conservatives uneasy with Giuliani’s strays from the ideological fold, while Vitter would gain great prominence under any Giuliani Administration for helping him at a crucial time. His appointment as a major campaign operative of Giuliani’s points to this. And, when analyzed, it’s not exactly a big risk for Vitter.
If the frontrunner Giuliani doesn’t end up grabbing the nomination, in contrast to the last several Republican presidential derbies, Vitter may lose a little luster back home, but not nearly enough to invite a conservative challenge nor really to empower any liberal opponent. Absent major mistakes, Vitter seems set for a long run as one of the state’s senators, affording him the chance to get out in front of a candidacy most conservatives, even those primarily interested in social issues, would have to support. The two most likely Democrat nominees, Sens. Hillary Clinton and Barack Obama, are among the most liberal in the body, especially on social issues. Few social conservatives could stand by and be complicit through non-participation in allowing such antithetical candidates the chance to get in the White House by deferring even lukewarm support for Giuliani.
By 2010, when Vitter must run for reelection, either a misstep will be forgotten largely, or his enhanced stature will make him more powerful – and potentially more helpful for Louisiana’s interests – than ever. While this isn’t exactly a case of politics making for strange bedfellows, it’s at least an instance of unusual ones. But, politically, it is a low-risk move for Vitter that may pay off substantially in terms of both electability and power.
12.3.07
GOP brakes on Blanco paying off with better policy-making
During last December’s special session, House Republicans offered the author of the session, Democrat Gov. Kathleen Blanco, a choice. Blanco wanted to spend huge sums of money on a number of projects including transportation projects as projected state surpluses began to increase. But the GOP lawmakers argues there was a hastiness in it all and they wanted time to get a better handle on economic conditions in the state and to derive plans for spending these alleged funds. Thus, any additional spending at this time they said should be offset by reductions in other areas. Blanco refused this entreaty, Republicans refused to raise the state’s spending cap, and the session fell apart.
The wisdom of the GOP approach recently received confirmation over the issue of roads improvements. The state faces a tremendous backlog of such funding of $14 billion which has gotten to the point that current revenues dedicated to roads in just a couple of years will no longer be sufficient to fully match federal monies available, exacerbating the problem even more. A number of solutions involving some kind of tax or fee increase have been floated, such as indexing to inflation gasoline tax levels and raising fees on vehicle registrations.
However, relying on these as a means of receiving the full match and to work preventing the backlog from growing, or even reducing it, rests on the tired old assumption that spending priorities don’t get met because not enough revenue is being squeezed from Louisiana taxpayers and roads users. Instead, it fails to comprehend that the priorities themselves are incorrectly ordered.
Unfortunately, Louisiana has a patchwork system of revenue dedications that often make no sense. While there are crazier examples both real and contemplated (such as tobacco taxes to fund teacher salary increases), one such extant is that sales taxes collected on vehicle purchases get dumped into the general fund. Instead, Independent state Rep. Joel Robideaux and Republican state Sen. Mike Michot argue, why not dedicate these to going into the Parish Transportation Fund, the instrument by which money is doled out to spend on state highways/local roads? This would boost by $300 million a year spending on roads.
Further, in legislation they are developing, Michot and Robideaux wish to reallocate funding in a manner that better addresses priority needs. At present, the state controls centrally the system. The proposal would give parishes more leeway in determining how to use the annual cut they get from the fund, governments which probably have a better grasp on where the true needs are.
Best of all, it would cost citizens no additional money. The authors calculate that growth in state sales taxes would be about $300 million this year, meaning just some restraint in spending increases on peripheral matters at the state level would in essence transfer money from low items to this high-priority one without confiscating more from the citizenry.
It’s not something that has seen the legislative light of day previously, and was not ready in December as details still are being worked out presently. It certainly is much better thought out than Blanco’s plan to just dump on a one-time basis hundreds of millions of dollars without little regard given to how it actually might be spent. This idea is a good example of how superior policy gets made when care and prioritizing are primary concern, rather than reducing policy-making to a race to spend recklessly the people’s resources.
The wisdom of the GOP approach recently received confirmation over the issue of roads improvements. The state faces a tremendous backlog of such funding of $14 billion which has gotten to the point that current revenues dedicated to roads in just a couple of years will no longer be sufficient to fully match federal monies available, exacerbating the problem even more. A number of solutions involving some kind of tax or fee increase have been floated, such as indexing to inflation gasoline tax levels and raising fees on vehicle registrations.
However, relying on these as a means of receiving the full match and to work preventing the backlog from growing, or even reducing it, rests on the tired old assumption that spending priorities don’t get met because not enough revenue is being squeezed from Louisiana taxpayers and roads users. Instead, it fails to comprehend that the priorities themselves are incorrectly ordered.
Unfortunately, Louisiana has a patchwork system of revenue dedications that often make no sense. While there are crazier examples both real and contemplated (such as tobacco taxes to fund teacher salary increases), one such extant is that sales taxes collected on vehicle purchases get dumped into the general fund. Instead, Independent state Rep. Joel Robideaux and Republican state Sen. Mike Michot argue, why not dedicate these to going into the Parish Transportation Fund, the instrument by which money is doled out to spend on state highways/local roads? This would boost by $300 million a year spending on roads.
Further, in legislation they are developing, Michot and Robideaux wish to reallocate funding in a manner that better addresses priority needs. At present, the state controls centrally the system. The proposal would give parishes more leeway in determining how to use the annual cut they get from the fund, governments which probably have a better grasp on where the true needs are.
Best of all, it would cost citizens no additional money. The authors calculate that growth in state sales taxes would be about $300 million this year, meaning just some restraint in spending increases on peripheral matters at the state level would in essence transfer money from low items to this high-priority one without confiscating more from the citizenry.
It’s not something that has seen the legislative light of day previously, and was not ready in December as details still are being worked out presently. It certainly is much better thought out than Blanco’s plan to just dump on a one-time basis hundreds of millions of dollars without little regard given to how it actually might be spent. This idea is a good example of how superior policy gets made when care and prioritizing are primary concern, rather than reducing policy-making to a race to spend recklessly the people’s resources.
10.3.07
Result shows pro-GOP, anti-incumbent trend continues
The next marker in the quest to figure out where the 2007 elections are headed came with the special election in House District 94. The term-limited unreliably conservative but entertaining (we will miss his banter in committee and on the House floor) state Rep. Peppi Bruneau will hand over the reins of the district just as the regular session starts, doing so he said to give the winner more seniority in the chamber, while critics said he was trying to better position to succeed him his son Jeb Bruneau .
I’ve noted that, with the coming of term limits for legislators and the increasingly apparent internal contradictions and invalidity of the liberal/populist ethos in Louisiana as the state gets kicked dragging and screaming into by events beyond its control, that Republicans and/or non-incumbents will make major gains in political contests this year. This contest proves interesting in this regard, for it is a reliably conservative district but with Bruneau the younger a kind of quasi-incumbent and having three other GOP challengers along with a pair of Democrats putting up a fight to prevent his ascension.
If Bruneau won outright, it would tend to support the Republican part of the hypothesis but not the incumbent one (whose only real strong support to date comes from the dismantling that newcomer state Sen. Ted Cassidy brought to potential-chamber-jumper state Rep. William Daniel IV in both Republicans’ quest in December for the Senate District 16 open seat). If another Republican won outright, that would provide strong evidence for both. Two Republicans, or even one, in a general election runoff would keep us guessing, but that Bruneau was denied an outright win would tend to bolster the anti-incumbent hypothesis.
And the answer? Certainly no sign that it won’t be a favorable Republican year, as Bruneau with 32 percent and another Republican, Nick Lorusso (endorsed by the Alliance for Good Government) with 25 percent, made the runoff. And, the fact that Lorusso pushed Bruneau into a runoff, not trailing him by much, may mean that anti-incumbent sentiment may swell in support of Lorusso.
One interesting dynamic was the two Democrats picked up 39 percent of the vote, with one not far behind Lorusso. Much of this vote could go to Lorusso out of spite of Bruneau. Running just one of them might well have gotten that one into the runoff, although it’s not likely anti-incumbent sentiment would cancel out partisanship and ideology leading Bruneau to win. No doubt this will displease my good friends at a rabidly pro-Democrat blog that occasionally links to this space who must feel like they have their fingers in the creaking Democrat majority dike in the state (I must correct them about one thing in that, as they refer to me as a “Republican operative,” that other than a GOP party registration I proudly acquired just after graduating high school I have no affiliation with the party).
It’s just one special election in one small part of the state, but it’s more evidence pointing to a favorable Republican trend this election cycle, and, given that Bruneau was forced into a runoff so his chances of winning are at best even money, that the anti-incumbent feeling is itself alive and well.
I’ve noted that, with the coming of term limits for legislators and the increasingly apparent internal contradictions and invalidity of the liberal/populist ethos in Louisiana as the state gets kicked dragging and screaming into by events beyond its control, that Republicans and/or non-incumbents will make major gains in political contests this year. This contest proves interesting in this regard, for it is a reliably conservative district but with Bruneau the younger a kind of quasi-incumbent and having three other GOP challengers along with a pair of Democrats putting up a fight to prevent his ascension.
If Bruneau won outright, it would tend to support the Republican part of the hypothesis but not the incumbent one (whose only real strong support to date comes from the dismantling that newcomer state Sen. Ted Cassidy brought to potential-chamber-jumper state Rep. William Daniel IV in both Republicans’ quest in December for the Senate District 16 open seat). If another Republican won outright, that would provide strong evidence for both. Two Republicans, or even one, in a general election runoff would keep us guessing, but that Bruneau was denied an outright win would tend to bolster the anti-incumbent hypothesis.
And the answer? Certainly no sign that it won’t be a favorable Republican year, as Bruneau with 32 percent and another Republican, Nick Lorusso (endorsed by the Alliance for Good Government) with 25 percent, made the runoff. And, the fact that Lorusso pushed Bruneau into a runoff, not trailing him by much, may mean that anti-incumbent sentiment may swell in support of Lorusso.
One interesting dynamic was the two Democrats picked up 39 percent of the vote, with one not far behind Lorusso. Much of this vote could go to Lorusso out of spite of Bruneau. Running just one of them might well have gotten that one into the runoff, although it’s not likely anti-incumbent sentiment would cancel out partisanship and ideology leading Bruneau to win. No doubt this will displease my good friends at a rabidly pro-Democrat blog that occasionally links to this space who must feel like they have their fingers in the creaking Democrat majority dike in the state (I must correct them about one thing in that, as they refer to me as a “Republican operative,” that other than a GOP party registration I proudly acquired just after graduating high school I have no affiliation with the party).
It’s just one special election in one small part of the state, but it’s more evidence pointing to a favorable Republican trend this election cycle, and, given that Bruneau was forced into a runoff so his chances of winning are at best even money, that the anti-incumbent feeling is itself alive and well.
8.3.07
Selective, self-serving information distorts health care debate
Reform, while desirable in the case of indigent health care in Louisiana, will threaten certain entrenched interests. Thus it is understandable why Michael Butler, LSU Health Sciences Center chief medical officer, might try to present a skewed picture of the quality of indigent care in the state.
Changing the system from a money-given-to-the-institution to a money-follows-the-person regime would pose problems for the charity hospital system run by the Louisiana State University system. Money would flow away from that organization into for-profit and nonprofit providers, in part because patients will choose these other options because of the services available and/or quality of care, and LSU and other state politicians do not want to see that happen because it would mean fewer jobs and less power.
Butler did his best to deny this reality by arguing at a press conference that “[c]ontrary to popular belief, the public hospitals ... are a valued asset for patient care. When people say we are not delivering high quality care, they are not being honest. Most are just too lazy to dig in deeper and pay attention.” Further, he said “There is evidence that charity does better than private.” In fact, as federal statistics show, it is Butler who is not being honest and needs to dig a little deeper and pay attention.
Note that Butler tries to establish two different arguments here, that the charity system is “high quality” and in some ways it is better than the private sector. The first is somewhat misleading: it all depends on how you define “high quality” but, more importantly, what if one could have “highest quality” instead that could come only from outside government hospitals? That connects to the second argument, that if we define the charity system as doing as well as the non-government sector, then perhaps that means there is the “high” or “highest quality” and no significant advantage there could be obtained by shifting more care to private institutions.
But when reviewing federal statistics in four areas, using just as an example the flagship institution in the system, the Medical Center of Louisiana New Orleans (“Big Charity”), it comes up short. These statistics deal with quality in the areas of heart attacks, heart failure, pneumonia care, and surgical care improvement/infection prevention. While Big Charity slightly outperforms New Orleans-area non-government hospitals on the first category, it does worse, sometimes much worse, on the other three. The news gets worse for other system hospitals. The other major facility, LSU Health Science Center Shreveport, does a little better relative to its area institutions, but the smaller ones seldom do as well, and sometimes much more badly, on average than their surrounding non-government institutions.
Conclusions drawn in the draft report by the Public Affairs Research Council also cast doubt on the quality of charity hospital indigent care. To quote it, “Overcrowded emergency room and outpatient clinics have caused diagnosis and treatment to be delayed for countless uninsured patients …. Louisiana charity hospitals since the mid-1990s show significant decreases in services delivered while budgets continue to rise.” Butler apparently disputed none of this at the press conference.
Butler trotted out some indicators showing in some areas the system does decently, perhaps even better than the non-government sector. However it is selective and he certainly ignores the substantial evidence that charity hospital performance lags that sector. In doing so, Butler does a disservice to the debate over this issue and appears more as a champion of vested interests than in improving indigent health care in Louisiana.
Changing the system from a money-given-to-the-institution to a money-follows-the-person regime would pose problems for the charity hospital system run by the Louisiana State University system. Money would flow away from that organization into for-profit and nonprofit providers, in part because patients will choose these other options because of the services available and/or quality of care, and LSU and other state politicians do not want to see that happen because it would mean fewer jobs and less power.
Butler did his best to deny this reality by arguing at a press conference that “[c]ontrary to popular belief, the public hospitals ... are a valued asset for patient care. When people say we are not delivering high quality care, they are not being honest. Most are just too lazy to dig in deeper and pay attention.” Further, he said “There is evidence that charity does better than private.” In fact, as federal statistics show, it is Butler who is not being honest and needs to dig a little deeper and pay attention.
Note that Butler tries to establish two different arguments here, that the charity system is “high quality” and in some ways it is better than the private sector. The first is somewhat misleading: it all depends on how you define “high quality” but, more importantly, what if one could have “highest quality” instead that could come only from outside government hospitals? That connects to the second argument, that if we define the charity system as doing as well as the non-government sector, then perhaps that means there is the “high” or “highest quality” and no significant advantage there could be obtained by shifting more care to private institutions.
But when reviewing federal statistics in four areas, using just as an example the flagship institution in the system, the Medical Center of Louisiana New Orleans (“Big Charity”), it comes up short. These statistics deal with quality in the areas of heart attacks, heart failure, pneumonia care, and surgical care improvement/infection prevention. While Big Charity slightly outperforms New Orleans-area non-government hospitals on the first category, it does worse, sometimes much worse, on the other three. The news gets worse for other system hospitals. The other major facility, LSU Health Science Center Shreveport, does a little better relative to its area institutions, but the smaller ones seldom do as well, and sometimes much more badly, on average than their surrounding non-government institutions.
Conclusions drawn in the draft report by the Public Affairs Research Council also cast doubt on the quality of charity hospital indigent care. To quote it, “Overcrowded emergency room and outpatient clinics have caused diagnosis and treatment to be delayed for countless uninsured patients …. Louisiana charity hospitals since the mid-1990s show significant decreases in services delivered while budgets continue to rise.” Butler apparently disputed none of this at the press conference.
Butler trotted out some indicators showing in some areas the system does decently, perhaps even better than the non-government sector. However it is selective and he certainly ignores the substantial evidence that charity hospital performance lags that sector. In doing so, Butler does a disservice to the debate over this issue and appears more as a champion of vested interests than in improving indigent health care in Louisiana.
6.3.07
Report confirms need for LA indigent health care overhaul
I was pleased to see the Louisiana State University Daily Reveille had the brainstorm of serving a public records request on its own administration to pry free a copy of the preliminary report by the Public Affairs Research Council that sent LSU system officials into a tizzy. The report is critical of the money-given-to-the-institution system of indigent health care in Louisiana, while promoting the money-follows-the-person reform resisted by Gov. Kathleen Blanco and the state’s vested health care interests.
However, I am disappointed that I received so little credit in the report, as over the past five months in this space much of what was in this report has already appeared (perhaps in the final draft they will cite my postings). PAR in this report drew almost all of the conclusions that I did: shift to money-follows-the-person to improve quality and efficiency of care, centralize medical education in just a few charity hospitals and dispose of the rest to help achieve these savings, and do not build a grandiose new “Big Charity” hospital in New Orleans as it should be there primarily for medical education, not as a charity provider.
The report makes one excellent point of which I was unaware. Despite medical education of some form occurring in most of the charity system’s units, the report indicates that often these hospitals are behind the times in treatments in many differing areas. Perhaps this is why their outcomes tend to be no better, and are often worse, than nearby non-government institutions. It indicates how a restructuring of medical education could be used to generate more federal dollars for the state in this area.
Disingenuous Montgomery uninterested in lowering taxes
When you get a politician of advanced years and long service such as state Rep. Billy Montgomery, chances are he’s forgotten more about politics than many ever knew. But in his case, some recent statements and actions by him suggest he’s also forgotten more about himself and how to best serve his constituents than they ever would care to know.
Montgomery has prefiled HB 36 which is designed to undo income tax increases courtesy of the so-called “Stelly Plan.” In 2002, the House passed (interestingly enough, the same-named) HB 36 which constitutionally increased these income tax rates, subject to a vote of the people as with any constitutional amendment which led to its narrow adoption.
Montgomery now calls this is mistake. “I believe most people were misled or didn't know exactly what the Stelly Plan did,” he recently said at a public forum. Apparently, “most people” included Montgomery himself, for he was part of the two-thirds legislative majority that voted in favor of HB 36 in 2002. It received exactly the 70 votes needed to pass it along to the Senate. If not misled or he didn’t know exactly the plan’s implications, then by definition he knew what it was about exactly and thereby aided and abetted in misleading people.
Assuming he himself was “misled” or “didn’t know exactly,” being that at the time Montgomery had been a member of the House for 15 years, despite all of that experience, by his own testimony Montgomery appeared to be confused and/or ignorant about the true nature of a bill he was voting on – yet he voted for it anyway rather than opting for a safer vote against. As it was, Montgomery’s vote was the one crucial vote that allowed the measure to continue into law.
In essence, Montgomery is trying to undo what he now calls a mistake, something that by himself alone he could have stopped five years ago had he been a wiser politician. Whether repealing what he foisted on the public years ago now is sufficient penance is one matter. But, the fact is, with this bill Montgomery really isn’t actually asking for an unambiguous tax cut, another matter entirely.
This is because for its provisions to go into effect, his prefiled HB 38 also would have to be passed. Part of that bill would lock in the lower income tax rates. But there’s more to it: another part of the bill would remove the prohibition on the state’s ability to place a sales and use tax on food for home consumption and consumer purchases of natural gas, electricity, water, and prescription drugs.
In other words, Montgomery’s intent is not to cut taxes, it is literally to repeal the Stelly Plan. Because in exchange for lowering income tax rates that by his crucial vote he helped to raise in the first place, he is inviting the Legislature to raise sales taxes. Significantly, these kinds of taxes disproportionately fall upon lower-income families.
The explanation for this behavior is simple: Montgomery, in violation of the spirit of legislative term limits, is running for state Senate District 37 later this year. He has no real interest in cutting taxes because, as his legislative career shows, the Democrat-turned-Republican has been a tax-and-spend liberal and would rather empower government by taking resources from the people than to empower people themselves. He just wants to fool voters in probably the most conservative district in the state into thinking he’s one of them.
If Montgomery were a quality elected official, he would not have made a mistake after 15 years of seasoning he now claims he’s trying to correct. If Montgomery were a true conservative, when the state is sitting on $3.2 billion in surplus funds he would be trying to cut taxes without any chance of raising them in another way, instead of giving with one hand and taking with another – appropriate to his tax-and-spend legislative career.
Either he’s disingenuous, a dunderhead easily misled or confused about his job, or wrong on the issues for District 37. Maybe it’s time for those voters to give Montgomery a retirement he richly deserves. And the guy that should lead him to it is Jay Murrell, but that's a subject for a future posting.
Montgomery has prefiled HB 36 which is designed to undo income tax increases courtesy of the so-called “Stelly Plan.” In 2002, the House passed (interestingly enough, the same-named) HB 36 which constitutionally increased these income tax rates, subject to a vote of the people as with any constitutional amendment which led to its narrow adoption.
Montgomery now calls this is mistake. “I believe most people were misled or didn't know exactly what the Stelly Plan did,” he recently said at a public forum. Apparently, “most people” included Montgomery himself, for he was part of the two-thirds legislative majority that voted in favor of HB 36 in 2002. It received exactly the 70 votes needed to pass it along to the Senate. If not misled or he didn’t know exactly the plan’s implications, then by definition he knew what it was about exactly and thereby aided and abetted in misleading people.
Assuming he himself was “misled” or “didn’t know exactly,” being that at the time Montgomery had been a member of the House for 15 years, despite all of that experience, by his own testimony Montgomery appeared to be confused and/or ignorant about the true nature of a bill he was voting on – yet he voted for it anyway rather than opting for a safer vote against. As it was, Montgomery’s vote was the one crucial vote that allowed the measure to continue into law.
In essence, Montgomery is trying to undo what he now calls a mistake, something that by himself alone he could have stopped five years ago had he been a wiser politician. Whether repealing what he foisted on the public years ago now is sufficient penance is one matter. But, the fact is, with this bill Montgomery really isn’t actually asking for an unambiguous tax cut, another matter entirely.
This is because for its provisions to go into effect, his prefiled HB 38 also would have to be passed. Part of that bill would lock in the lower income tax rates. But there’s more to it: another part of the bill would remove the prohibition on the state’s ability to place a sales and use tax on food for home consumption and consumer purchases of natural gas, electricity, water, and prescription drugs.
In other words, Montgomery’s intent is not to cut taxes, it is literally to repeal the Stelly Plan. Because in exchange for lowering income tax rates that by his crucial vote he helped to raise in the first place, he is inviting the Legislature to raise sales taxes. Significantly, these kinds of taxes disproportionately fall upon lower-income families.
The explanation for this behavior is simple: Montgomery, in violation of the spirit of legislative term limits, is running for state Senate District 37 later this year. He has no real interest in cutting taxes because, as his legislative career shows, the Democrat-turned-Republican has been a tax-and-spend liberal and would rather empower government by taking resources from the people than to empower people themselves. He just wants to fool voters in probably the most conservative district in the state into thinking he’s one of them.
If Montgomery were a quality elected official, he would not have made a mistake after 15 years of seasoning he now claims he’s trying to correct. If Montgomery were a true conservative, when the state is sitting on $3.2 billion in surplus funds he would be trying to cut taxes without any chance of raising them in another way, instead of giving with one hand and taking with another – appropriate to his tax-and-spend legislative career.
Either he’s disingenuous, a dunderhead easily misled or confused about his job, or wrong on the issues for District 37. Maybe it’s time for those voters to give Montgomery a retirement he richly deserves. And the guy that should lead him to it is Jay Murrell, but that's a subject for a future posting.
5.3.07
State's increased cost figures for reform plan dubious
Perhaps the best argument used by opponents of indigent health care reform in Louisiana is that it would cost more money than with the present system. Of course, the argument conveniently ignores that the present cost level helps to produce the worst health outcomes in the nation, and that because reform would make for a more efficient system, that in time better care for less money per patient would result. But it is logical that in the short run, with two systems operating beside each other as the old money-given-to-the-institution system fades away the new money-follows-the-person system will grow, that costs would be higher.
But the revelation of some numbers dealing with indigent care pokes holes in this large increased-cost assertion, even in the short-run – something which the federal government, eager to see the change, has said all along while it’s been the state and the state only that has claimed costs would be quite a bit higher.
Statistics show that money spent on the charity hospital system, some units of which also feature some advanced medical training hard to replicate outside of the public sector, totals $912 million. In addition, $1.1 billion is spent on reimbursements to private institutions dealing with the indigent and those on Medicaid. In other words, over $2 billion is spent mostly on the indigent, with some of it going to medical education and Medicaid reimbursements to institutions. Another $361 million goes to reimbursement of private physicians for Medicaid patients.
In other words, the state spends about $2.4 billion on the indigent and poor (most people on Medicaid would be uninsured without it, essentially making them part of the indigent care system) with some of that used for medical education. It says the indigent portion of that is $935 million, but reform plans it says would cost over twice that.
Reviewing these numbers, the state’s figure doesn’t make sense. Is it arguing that the reform is so expensive that it essentially would double the state’s costs in this area? Then why are other states, some whose relative wealths are similar to Louisiana’s, moving in that direction and no other state maintains a charity system if it’s supposed to work so well? More importantly, does this imply that Louisiana is underfunding care for the poor and indigent by 30 percent presently?
The federal government has conjectured that the real initial extra cost of the system may be as little as $100 million a year. Given that it is hard to believe that a charity system is half the cost of a reformed system where the indigent would be given vouchers to purchase their own health care (then why isn’t every other state doing it?) and that the bulk of $2 billion a year already covers the indigent (which sounds like the state’s estimate, which it never has publicly released the method by which it was calculated, simply is taking most of what is spent on reimbursements to private institutions and saying that is the extra billion), that the federal government’s increased cost projection seems much closer to the truth than the state’s.
But the revelation of some numbers dealing with indigent care pokes holes in this large increased-cost assertion, even in the short-run – something which the federal government, eager to see the change, has said all along while it’s been the state and the state only that has claimed costs would be quite a bit higher.
Statistics show that money spent on the charity hospital system, some units of which also feature some advanced medical training hard to replicate outside of the public sector, totals $912 million. In addition, $1.1 billion is spent on reimbursements to private institutions dealing with the indigent and those on Medicaid. In other words, over $2 billion is spent mostly on the indigent, with some of it going to medical education and Medicaid reimbursements to institutions. Another $361 million goes to reimbursement of private physicians for Medicaid patients.
In other words, the state spends about $2.4 billion on the indigent and poor (most people on Medicaid would be uninsured without it, essentially making them part of the indigent care system) with some of that used for medical education. It says the indigent portion of that is $935 million, but reform plans it says would cost over twice that.
Reviewing these numbers, the state’s figure doesn’t make sense. Is it arguing that the reform is so expensive that it essentially would double the state’s costs in this area? Then why are other states, some whose relative wealths are similar to Louisiana’s, moving in that direction and no other state maintains a charity system if it’s supposed to work so well? More importantly, does this imply that Louisiana is underfunding care for the poor and indigent by 30 percent presently?
The federal government has conjectured that the real initial extra cost of the system may be as little as $100 million a year. Given that it is hard to believe that a charity system is half the cost of a reformed system where the indigent would be given vouchers to purchase their own health care (then why isn’t every other state doing it?) and that the bulk of $2 billion a year already covers the indigent (which sounds like the state’s estimate, which it never has publicly released the method by which it was calculated, simply is taking most of what is spent on reimbursements to private institutions and saying that is the extra billion), that the federal government’s increased cost projection seems much closer to the truth than the state’s.
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