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10.4.08

Opponents to LA indigent care reform show hands

Battle lines have become clearer as a result of testimony in front of the Louisiana Senate’s Health and Welfare Committee regarding the future of indigent health care, starkly illuminating the direction of this policy the decision about which could provide better health care at reduced costs if vested interests don’t get in the way.

A group of private health care providers and insurers argued for a modified money-follows-the-person system to replace the current money-goes-to-the-institution indigent care model that, unique among the states, Louisiana follows. Its plan calls for steering 61,000 uninsured adults into managed-care "medical homes." The group said the premiums would average $194 a month for an annual cost of $156 million, which would come from the "disproportionate share" of Medicaid dollars that now pays for most of the care in the Louisiana State University-run charity system.

But members of the committee were unimpressed, and their comments are instructive in terms of how opponents will try to attack this reform if instituted statewide – policies that more states are adopting to improve outcomes often at reduced costs for the indigent. State Sen. Cheryl Gray remarked the idea didn’t seem to have an endorsement from LSU nor the state’s Department of Health and Hospitals.

As far as the latter, its Secretary Alan Levine made approving noises about the plan but stopped short of endorsing it. This reluctance should prove temporary on theoretical and practical grounds. Levine probably is looking to roll out a plan similar to that he helped institute in Florida which would skip the “medical home” concept and go straight to the vouchers, but he is not yet ready to do so and tactically probably would wait until the next fiscal year after the legislative session has ended (the state needs no legislative action on this, just approval of a waiver request to the federal government).

Also, Levine needs to finish a recommendation on the size of the new “Big Charity” hospital in New Orleans. Simply, a plan along these lines would mandate a decrease in the size of the palatial facility envisioned by the Kathleen Blanco Administration, and would make sense only if Levine and his boss Gov. Bobby Jindal backed a smaller-sized hospital. And, of course LSU never would endorse such a plan because it would be taking money from that agency, so Gray shouldn’t hold her breath on this one.

The fact that temporary facilities currently serve the New Orleans-area indigent is why the plan envisioned just starting in that area; politically speaking, it wouldn’t threaten existing LSU resources in other areas of the state. State Sen. Sherri Smith Cheek thought that wasn’t good enough and said she couldn’t justify that to her constituents, that it was unfair. But if Levine rolls out a similar plan to go statewide, watch for Cheek to change dramatically her tune, to sound like state Sen. Joe McPherson.

McPherson, who operates a series of nursing homes, called the cost figures “unrealistic” and said health care premiums for his employees are at least 250 percent higher. Understand that this conflict is quite personal to McPherson: if the state succeeds in steering money away from institutions on this front, his nursing homes, the collective of which in Louisiana are probably the most inefficient users of taxpayers dollars in the entire nation according to the Louisiana Legislative Auditor and which typically derive the vast majority of their revenues from government payments, might be next.

Of course, being in an industry so heavily regulated and subsidized by government, McPherson is a poor judge of what actual costs are. Using a pioneer state in this kind of plan extending not just to the indigent but the uninsured, Massachusetts, a state with higher costs but healthier people, had for a standard set of benefits a target premium for a 37 year-old single male at $250 a month, but the marketplace currently actually prices it at $184. That is consistent with the coalition’s estimate, not McPherson’s. (And Massachusetts is seeing lower costs and improved outcomes.)

Expect these kinds of arguments to resurface if and when Levine forwards an indigent care plan, integrated with a smaller Big Charity, along the lines of the Massachusetts model restricted to the indigent. This is because senators like these and their allies have as their primary goal not more efficient delivery of health care to the indigent, but that big government be as involved as possible in its delivery to protect powers, privilege, and patronage of the existing LSU hospital system. They are believers that big government makes better decisions than do individuals, and that state employees’ jobs and agency resources must be protected.

Hopefully, that is not the attitude of the Jindal Administration and it will prove as such over the next several months.

9.4.08

Jindal impresses on outlay reform, but challenges remain

Gov. Bobby Jindal’s declaration that the capital projects he wants the state to pursue are only those approved in prior years and constitute nothing new casts optimism and uncertainty into the reform process.

Under the current process, far more items are stuffed into the capital outlay budget each year than constitutionally the state can spend money on. The items that pass muster really emanate from the governor’s office when the State Bond Commission is brought spending proposals and then approves, a body lined with gubernatorial allies. As a result, roughly three-quarters of authorized spending annually lies on the table where, maybe, in future years it might actually get funded.

Jindal has said for this year’s round, he’s going to take previous years’ choices and not introduce anything new. He can say legitimately that he is not ignoring any new broad needs because the state spent over a half billion dollars last month in a special session on such needs.

Impressively, Jindal also issued an executive order with new guidelines to determine spending priorities. A more formal ranking system would be imposed, and anything local would have to have some commitment from local governments. Jindal also backs reform bills that would stop the state from making future commitments that do not have a scheduled appropriation attached to them.

This sets the state up well for reform of the process, but questions remain. For one, until the process reform becomes law, nothing stops the Legislature from doing the same thing again, loading up this years capital outlay bill with three times the authorized amount – except for a committed governor, willing to use a line item veto on items that he thinks will bust that budget and, most importantly, telling legislators he will do that.

Also, the interim procedures established in the executive remain hostage to politics. The Jindal Administration still will have to choose if all goes well, just one out of three dollars instead of one out of four, and make sure these are the best choices. And the Legislature will have to be sufficiently under control not to pass instruments overriding the executive order.

Most importantly, Jindal’s crew must choose wisely. It’s assumed the order’s standards will be used, and Jindal must resist political ploys to bend them. Finally, even if the reform bill gets through and moots much of this interim strategy in the future, nothing about this addresses the nagging problem of earmarks that appear in the general appropriations bill, where only stern threatened use of a line item veto can rid it of projects that almost uniformally are of very low priority and really do not help the state as a whole.

Especially the executive order ratifies Jindal’s pledge of reform of state spending priorities. Now he needs to follow through by getting the reform bill into law and holding fast threatening, even using, his veto power, despite the political challenges no doubt coming his way.

8.4.08

Paranoia, selective arguments mark SB 561 opponents

All the fire and brimstone surrounding SB 561 on the docket of the Louisiana Legislature tells more about the paranoia and insecurities of those trying to create a controversy than the bill’s language actually suggests.

Sen. Ben Nevers introduced this bill to increase academic freedom in Louisiana schools. It asserts that it is to create an environment within public elementary and secondary schools that “encourages students to explore scientific questions, learn about scientific evidence, to help students develop critical thinking skills, and respond appropriately and respectfully to differences of opinion about controversial issues.” Also, it is to prohibit the state or its officials from interfering with this.

But the innocuous language has gotten some people very upset. People associated with organizations that claim they are interested in education have spoken publicly and sent out e-mail messages calling the bill essentially a “backdoor” for the teaching of creationism in schools. Interestingly, they base this interpretation (one which, in its reading, is exceptionally broad in taking selected passages) not on the actual language of the bill, but on the bill’s digest.

A bill’s digest is written by a legislative staffer and has no legal importance. The actual wording, if these alarmists would care to read it instead of dispensing with it because it doesn’t fit their agenda, contains the following section what that the law is to do: “protects the teaching of scientific information, and this section shall not be construed to promote any religious doctrine, promote discrimination for or against a particular set of religious beliefs, or promote discrimination for or against religion or non-religion.”

It couldn’t be less ambiguous that the bill does not in any way endorse that creationism or any other religious or non-religious (like the imperfect theory of evolution) idea be advocated uncritically in the classroom. It simply buttresses the academic freedom of instructors to explore the merits and demerits of any particular scientific theory.

The reaction of those who argue against academic freedom in this instance is telling, however. One wonders whether they see the theory of evolution itself as a religion, given they are so scared of any critical examination of it.

Any educator at any level should support this bill for the protection it gives the concept of academic freedom – the pursuit of which seems to make some who call themselves educators very nervous.

7.4.08

LA Democrat superdelegates will go with most electable

There’s much confusion about the role Louisiana’s Democrat Party Leaders and Elected Officials (PLEO) delegates (“superdelegates”) will play in the party’s nomination of either Sens. Barack Obama or Hillary Clinton for the presidency. Having taught how the Democrats’ system works for almost two decades, let me be of assistance.

Initially, it must be understood that the complicated system of the Democrats – no unit rule decisions by state or territory or Democrats Overseas (that is, no winner-take-all), the presence of the PLEOs, and the diversity mandates (for example, half of delegates must be female) – came as a result of the disastrous 1972 nomination of former Sen. George McGovern. Simply, the existing system permitted popular passions of the party’s most liberal members to be translated into an unelectable candidate. Thus, the reform efforts beginning with the party’s 1974 meeting and tweaked several times since was to give those with a substantial stake in party affairs – officers and elected Democrats – significant weight in the nomination process while balancing that with grassroots representation of all meaningful parts of the party. It was believed the superdelegates would use good political sense in their choices to vote for the candidate most capable of winning in the fall.

In short order, they almost became critical deciders of nominations. Both in 1980 and 1984 the eventual nominee barely squeaked out enough “pledged” delegates to have an absolute majority (note: technically, no delegate is officially “pledged” among Democrats – delegates apportioned as a result of primaries essentially are chosen by the candidate’s campaigns themselves, and of course pledged caucus delegates already have promised, and are expected to be loyal to that candidate, but any delegate can vote for any nominee although defection is very rare). Both Obama and Clinton will fall far short in 2008, making the superdelegates, who represent almost a fifth of the total nomination votes, in fact the critical deciders.

So, in analyzing what superdelegates intend to do as a matter of course it is mistaken and facile to assume generally they’ll follow some standard such as how a state’s vote turned out. Some who have been early backers of a candidate out of loyalty will continue that support regardless of anything else, and those who rate the candidate’s chances and equal for November victory might use a popular vote standard. (Note also that not all superdelegates are yet picked – each state gets anywhere from one to several picked by the party’s leadership, usually at the state chairman’s discretion; Louisiana’s singleton will be chosen May 3).

But the large majority of these officials will use a very parsimonious decision rule in making their choice (hopefully from the national party’s perspective by a self-imposed Jul. 1 date): who has the best chance of beating presumptive Republican nominee Sen. John McCain? That’s regardless of any other consideration, especially since both candidates can claim a mandate from the party: likely after all nomination contests cease in early June, Obama will have a non-PLEO delegate lead in the neighborhood of a hundred, but Clinton actually will have received more popular votes and will have outperformed Obama in the predicted closely contested “swing” states.

While it’s tempting to try to reduce the complexity of the situation to buzz phrases, such as believing Obama has the nomination wrapped up because blacks would abandon the party in the fall, it also misunderstands the situation. Using this as an example, if superdelegates swing the nomination to Clinton, it will be because many of them believe Clinton has a better chance of winning even if some blacks (actually, it won’t be many) might sit out the presidential election because Obama doesn’t get the party’s nod.

It’s still anybody’s contest, which is why so many Louisiana superdelegates have yet to give public endorsements. They’ve got their fingers in the air, seeing which way the wind blows, and they’ll decide when they feel certain enough one candidate has a better shot than the other.

5.4.08

Scalise almost certain, Jenkins favored to win in May

Runoff elections for Louisiana’s major party candidates for the two U.S. House seats recently vacated produced a congressman-in-waiting, but have left the other indeterminate.

State Sen. Steve Scalise bested state Rep. Tim Burns to win the Republican nomination in the Second District. Barring incredibly unlikely circumstances, Scalise will join the long line of GOP representatives in this seat next month.

The Sixth District is another matter. As expected since he was less than a hundred votes from avoiding a runoff last month to secure the GOP nomination, former state Rep. Louis “Woody” Jenkins grabbed that slot. And the results on the Democrat side, with state Rep. Don Cazayoux prevailing over colleague Michael Jackson, give Jenkins the edge in the upcoming general election.

Jenkins assuredly would have beaten the liberal black Jackson, but the white liberal Cazayoux would have an easier time of masquerading as a conservative making this a closer contest. Cazayouz is vulnerable on many issues as his voting record in the state Legislature demonstrates, so Jenkins’ optimal strategy is to turn this into a contest about ideology especially in the use of tax dollars. For example, just last session, Cazayoux voted to bust the state’s spending cap that facilitated using a lot of one-time money for recurring, now entrenched spending, to authorize building a palatial new charity hospital in New Orleans even as Baton Rouge struggles to get money to build its own new charity hospital, and to fund pay increases for “ghost” workers (vacant positions) in state government as well as to not cut those positions and continue funding them instead of allocating the money elsewhere..

While Cazayoux is not as liberal on social issues he can’t top Jenkins in conservatism on that. By contrast, Jenkins can tie Cazayoux into the biggest whipping boy among (at least among the public) concerning Congress, earmarks. In 2007 alone, Cazayoux steered $131,000 in state taxpayer dollars directly to New Roads and Pointe Coupee Parish, and perhaps more to more obscure nongovernmental organization.

Cazayoux, by contrast, will keep clear of ideology and try to make the race turn on personality. But even here, his upside is limited. His best card, saying Jenkins got fined in 2002 by the Federal Elections Commission for not reporting he got a phone bank list in his 1996 very narrow loss to Sen. Mary Landrieu, will be relevant only to his likely supporters and Jenkins can turn it around by asserting he was the victim of corruption in the 1996 contest (even as a U.S. Senate investigation could not definitively demonstrate enough fraudulent activity cost him that election).

Cazayoux might draw a false sense of security from the fact that over ten thousand more voters participated in the Democrat primary than Republican, but that would make him fall into the trap, as historically has been the case, of underestimating Jenkins’ support. Note first that Jenkins given his primary advantage was assumed to be the winner, depressing GOP turnout who will be there to vote for Jenkins in May. Also, independents were allowed to vote in the Democrat primary but not Republicans, and far more Democrats typically vote for GOP candidates in national contests than vice-versa, meaning a number of Jenkins voters who forcibly were sat on the sidelines this time will get their chance in May.

This is Jenkins’ race to lose. If he has the resources and makes the contest relentlessly ideological, it will be a GOP sweep on May 3.

3.4.08

No fancy plans required to ameliorate workforce needs

Gov. Bobby Jindal has made clear his primary emphasis in the regular session of the Legislature in 2008 is workforce development, identifying the problem needing solving as disconnection between the kinds of skills graduates have coming out of public secondary and tertiary institutions and what the economy demands. But to correct this, we need first to understand the true nature of the problem which many have failed to correctly grasp.

If one is to argue there is too many offerings for bachelors’ degrees and not enough for associates’ degrees or vocational training, to say it is because of the whims of higher education officials largely misses the point. Louisiana’s problem in this regard is not there are too many people getting bachelors’ degrees and beyond – far from it, as the state ranks among the lowest in terms of the proportion of its population with these degrees which are the backbone of any economy that wishes to develop.

Nor is it accurate to maintain that passing control of tuition from the providers who ought to know something of the costs of education delivery, the universities, to largely uninformed politicians would not improve the situation. Louisiana is the only state that is backwards enough to leave tuition decisions in the hands of the Legislature. In fact, it is this very politicization of education that has skewed education needs from workforce needs.

It was politics that gave Louisiana too many four-year institutions in the first place. Note that Illinois, with three times-plus the population of Louisiana, has just about as many four-year institutions (public and private) as does Louisiana, while it has more than four times the number of two-year schools. Simply, schools outside of areas of real need, often in smaller cities or too many in bigger cities, were allowed to exist and grow to grant bachelors’ degrees and graduate degrees, usually at the behest of area legislative delegations looking for prestige.

Unfortunately, the overbuilt nature of senior institutions just isn’t going to go away. Bluntly (and sorry if it hurts the feelings of my colleagues at these institutions, but they know the veracity of this statement), there’s no reason to have such institutions 60 miles from both Baton Rouge and New Orleans, or 70 miles from Shreveport, or historically black institutions within 10 miles of large institutions in New Orleans, Baton Rouge, and Ruston. But that’s the situation the state must live with.

Thus, if the problem is too few two-year degrees or less offered relative to four-year degrees – which, again, are relatively too few in Louisiana already – the problem rests on the shoulders of the leaders of the four-year schools and their governing bodies only insofar to the extent that they themselves do not offer more in the way of associates’ degrees and certain certificate programs to meet this need.

Practically, this is the quickest and most effective way to use resources to close the education-workforce gap, not name-calling and suggestions that the dysfunctional legislative control of tuition continue. Besides removing legislative control over tuition, there’s no legislative solution needed here, just a willingness by the state’s education leaders to provide this kind of education where appropriate.

2.4.08

Blind spot on development imperils Jindal's agenda

To date, the talk of Gov. Bobby Jindal, and to some extent his actions, has been great on economic policy. He has said he wants to make Louisiana more business-friendly with the ultimate step being reduction, if not elimination, of income taxes both individual and corporate. He has started to back that up with the elimination of three nuisance taxes on business in the previous special session. But in all of this, he seems to have the same curious blind spot that did his predecessor in that, according to his premier budget, it’s necessary to prefer big game hunting than casting bread on the waters to achieve economic growth.

Jindal’s Secretary of Economic Development Stephen Moret is the point man on efforts to get $307.1 million of nonrecurring surplus funds dumped into a fund set aside to attract large employers which already has a $140 million balance. Both in practical and philosophical terms this allocation seems unwise and, in a related question, begs whether Moret is right for the job especially given his salary demands.

Moret claims the fund needs more money because other states are doing it, particularly large projects may need it, and the present balance could be gone after landing a project. It is possible that the increase could lure a project whose return to the state in terms of tax revenues could exceed the amount give up over the long haul, but, congruent to the theme of Jindal’s that proper priorities in spending will promote economic development, it’s hard to argue this is the right expenditure at this time.

1.4.08

Unbelievable good sense overtakes NW LA governments

Political watchers on both sides of the Red River were stunned by a series of announcements by local politicians that threatened to turn upside-down completely the political landscape of Caddo and Bossier Parishes and their principal cities Shreveport and Bossier City.

At a news conference jointly scheduled by leaders of the parish and city governments, not only did these officials promise sweeping new policies to be introduced, but an entirely new form of government that essentially would abolish their present forms. The conference, held at the Shreveport Convention Center, brought smiles to the operators of the city-owned facility who said the big crowd attending would assure that the Center would at least break even financially for the year.

The new form of government would make the two parishes and all their municipalities federative in nature, which some power retained by each unit but with larger decisions made by an elected assembly with representatives from each unit. “All our governments have concluded that local government is too fragmented and by working all together, we can provide more and better services to the public for reduced costs,” said Shreveport Mayor Cedric Glover. “I’ve been an elected politician all my adult life,” he noted, and he said the cost savings by eliminating the number of area elected officials to one-fifth the current amount and including the elimination of his job “would be a fitting end to my political career.”

31.3.08

Jindal address plays safe, leaves guessing for future

If you’re looking for radical change coming from Gov. Bobby Jindal this legislative session, you can’t find much of it in from his State of the State address prior to the opening of the 2008 Regular Session. That doesn’t mean it won’t eventually happen, while it does indicate Jindal’s strategy of caution for his first year in office amid potentially hard fiscal times for the state in the near future.

Jindal’s campaign last year promised three broad things: reducing the size and spending of government, empowering people rather than special interests, and shifting spending priorities. What he plans, according to things like his budget, to serve up this session is little of the first, some of the second, and more of the third – but you couldn’t tell from his speech which concentrated on priorities only, and the uncontroversial items at that.

Best exemplifying shifting priorities is the signature item intended by Jindal, workforce development, more perestroika than anything else the most radical change of which is dismantling the state’s Department of Labor into a more decentralized system, and some changes to education delivery. But nothing was heard concerning related items already released by his administration that are much more controversial, such as merit pay for teachers and pumping over $300 million into a fund to entice large-scale employers.

Some glimpses or far-reaching change did sparkle throughout his message. Using education as an example, Jindal discussed things such as a “teachers’ bill of rights” and laws to increase penalties against teacher assault. But mostly he touched on technocratic issues, making government work better, and not much on announced policy changes that would shift power to people, such as increased access to private schools that also will improve public education through competition.

So Jindal mostly played it safe in his address, championing popular items or saying he would make government work better which nobody is against. This continues the debate about Jindal the leader: will he truly lead the state in a different direction, or just do a better job in directing the state to a place not very different from what we have now? While factors such as looming future deficits as federal recovery money peters out and fixing spending difficulties introduced by former Gov. Kathleen Blanco do constrain what Jindal can do, on its surface this address seems to indicate the latter.

With that in mind, in keeping with my habit of grading these efforts, I’ll give him a B-. But for that grade to go any higher in future years, or even to prevent it going lower, we’ll need to hear more about empowering people and reduction of government even if he can get government working better. Because when government takes resources from the people and uses them in places it shouldn’t be, how well it does that is entirely a moot point.

30.3.08

Jindal agenda success brings slanted media pieces

The Gov. Bobby Jindal express tries to crank itself up again for the regular session after he pretty much got what he wanted in two prior special sessions. On its eve, we also got a reminder that there are still a number of people opposed to his conservative, reformist agenda who are desperate enough to try to create a non-story to slow it down.

A journalist who has shown past animosity towards Jindal (as well as to those who dare criticize the media) reported that a freshly-approved expenditure would benefit the business of a contributor who not only gave Jindal the maximum $5,000 contribution in his campaign, but whose companies in which he had an interest did so, as well as apparently several of his relatives who gave smaller amounts, or who gave to an organization associated with the state Republican Party which expended some funds on behalf of Jindal. The state Legislature appropriated $14 million to go to port expansion in Terrebone Parish. The donations were both legal and perfectly transparent, and the appropriation was deliberated and passed in full public view as well.

Yet the article insinuates differently, using itself as a vehicle to trot out some tiresome Jindal opponents. One discussing the contributions and appropriations, state Sen. Joe McPherson like a trained seal barks, “You’re talking about legal corruption.” As if McPherson is in any position to talk – scan through his campaign finance records all the way back to his initial 1999 run for office and one will find the nursing home operator has substantial contributions from that industry, people in that industry, and from people in and the medical industry as whole (before Jindal became governor McPherson had been chairman of the Senate Health and Welfare Committee), with labor unions finishing a strong second in contributions to him. (Of course, the article mentions none of this, nor of the $9,000 state Democrats gave him in 2007.) If McPherson finds this evidence enough to argue Jindal in involved in a form of corruption, then McPherson himself is awash in corruption.

Then there are those who opposition to Jindal has them cast aside objectivity. This incident is “a smoking gun” sniffs one, and another calls it “legalized bribery,” ignoring the facts behind the series of events: the idea of the expansion started two years ago under former Democrat Gov. Kathleen Blanco and was spearheaded by someone who hardly was a supporter of the Republican Jindal, Democrat state Sen. Reggie Dupre. It was virtually complete by the time Jindal was in any position to exert any influence on it at all. Not only that, but if the deal seemed shady in any way, the entire Legislature could have killed it; instead, it approved it overwhelmingly.

Finally, a related point of contention is that current laws – because of First Amendment rights as the article does point out – allow the kinds of donations made to Jindal, McPherson, and others, it’s implied that they are intentionally made too obscure and mentions legislation defeated during the first special session would have made it easier to identify sources of contributions (even as the article negates its own premise in that it is publicizing these supposedly obscure donations). What it doesn’t say is that Jindal backed that legislation but too many legislators (stating mainly by reason of complexity in administering) were against it.

It bears repeating – nothing that has happened here is illegal, immoral, or unethical. Contributions were received legally with full disclosure and an open public policy process (which largely did not involve Jindal) full of checks and balances did its job. So why is this a story?

Because it’s an opportunity for Jindal’s opponents to try to erode his political capital by making appear something that he is not, presumably as the public would be less likely to support him and, thus, other elements of his agenda. Jindal has said (at least in the long run) he will remake Louisiana, reducing the size and spending of government, empowering people rather than special interests, and shifting spending priorities. Some want him to fail because this runs counter to their political liberalism and/or his success in this agenda will make him a future national leader and he can bring that agenda with him. In order to stop him, even the most capricious charges will be directly or indirectly brought against him.

(Contrast this with the Louisiana media’s treatment of far more compelling stories of potential corruption, liberal Democrat Sen. Mary Landrieu’s tainted campaign donation incident or her apparent campaign-cash-for-earmark episode. Despite very suspicious timing and evidence on both accounts, it took the national media to break the story and only belatedly did the Louisiana media hop on board.)

This is an article that better deserved placement on the opinion pages than in the newshole. But don’t expect it to be the last of its kind, either, as long as Jindal is governor and continues to enjoy success.