Premium Plan
For the first time in years,
the state is starting to reach a consensus on health care reform. The only
question: how to pay for it?
By Nathan Stubbs | 11/22/2006
Miles Bruder knows all too well that significant heath care
policy reform in Louisiana isn’t going to happen overnight. For the past three
years, Bruder has been involved with a series of quasi-government committees
working to build consensus on how to overhaul Louisiana’s public health care
system, first on staff with Gov. Kathleen Blanco and now as director of health
policy for the Louisiana Recovery Authority. The work has at times seemed to
move at glacial speed. Even though most people agree that Louisiana’s health
care system is broken (it ranks near the bottom of all states in health care
services), getting all the parties involved to agree on how to fix it hasn’t
been easy. So when a 40-member panel — made up of a cross-section of government,
business and academic representatives — recently approved a plan for overhauling
public health care in the greater New Orleans area, Bruder saw it as a
significant breakthrough.
“We got a 40-member panel to unanimously agree,” Bruder says. “That’s been a
goal of ours for three years now. We’ve been criticized for a long time for just
meeting and meeting and meeting. I’m very excited that it’s finally getting
moving.”
But while the panel, known as the Louisiana Healthcare Redesign
Collaborative, may have agreed on a new model for public health care, it’s still
a long way from becoming reality. Any makeover of the current system will
require the approval of the state Legislature, which has been traditionally wary
of any radical changes in health care delivery. And U.S. Department of Health
and Human Services Secretary Michael Leavitt, who offered federal assistance for
the redesign, has balked at the hefty price tag that comes with the committee’s
current plan.
Formed at the request of Leavitt, the Louisiana Healthcare Redesign
Collaborative was created to help the hurricane-ravaged New Orleans area rebuild
with a progressive new model for delivering public health care. While the
committee’s plan would initially be set up only in the storm-struck parishes of
Orleans, Plaquemines, St. Bernard and Jefferson, the plan calls for the model to
be adapted across the state over the next five years. And Leavitt expressed hope
that it would also become a national model for other states to eventually
follow.
“That Secretary Leavitt is giving us so much of his personal attention, this
is a blessing,” notes Bruder.
The committee’s proposal, submitted last month, is visionary in its approach
to transforming the state’s health care system. The plan incorporates a number
of ideas many health care policy experts have been advocating for Louisiana for
years: eliminating the “two-tiered” system of health care in Louisiana, where
the insured get services almost exclusively through private providers and the
uninsured are directed to separate public “charity” hospitals; setting up more
primary and preventative clinic-based care that will reduce the need for costly
emergency room trips; creating a paperless, electronic system of health records
that is cheaper to maintain and easier to transfer with patients; putting less
resources in institutionalized charity hospitals and specialized care centers;
and focusing on getting more uninsured patients some type of coverage.
“Most of this is targeted toward the small businesses,” Bruder says, “which
are 95 percent of the businesses in Louisiana. They don’t have a bulk of
employees that makes health insurance coverage affordable enough. We would
simply be subsidizing the purchase of that insurance.”
But the new vision won’t come cheap. The proposal requests $150 million for
hospitals that remained open in the wake of Katrina and another $120 million
annually toward recruiting and retaining physicians and nurses. If implemented,
the new programs and expanded Medicaid coverage will total an additional $522
million a year on top of what the state now pays. This does not include another
$650 million LSU is seeking from both FEMA reimbursement and federal grant
dollars to rebuild its Big Charity hospital in New Orleans as a state-of-the art
medical education facility.
According to State Sen. Tom Schedler of St. Tammany Parish, “There is a big
disparity between the [state] Department of Health and Hospitals’ analysis of
the costs to implement this versus what [the federal government’s] cost is. They
think the changes need to be done a lot cheaper.”
Schedler, who sits on the health and welfare committee in the state Senate,
has been pushing for major reforms to Louisiana’s charity hospital system for
almost a decade now. He’s generally in favor of all the reforms being proposed
now, but he’s not convinced of their financial feasibility. His main concern
lies with LSU’s proposal to build a new 350-bed Big Charity hospital in New
Orleans. While the redesigned health care model reduces the need for large
charity hospitals for the uninsured, LSU and other state officials insist the
university needs a sizeable medical training hospital in New Orleans in order to
sustain its medical school there. The proposed solution has been to build a new,
state of the art Big Charity hospital, with an emphasis on cutting-edge medical
research that would help bolster LSU’s New Orleans medical school and at the
same time put the hospital in a position to compete with the private sector for
paying customers, as well as taking in uninsured patients.
Schedler says the plan sounds good, but it is based on a questionable
business model — one that assumes that by the time the hospital is built, in
another six years, New Orleans will be back to a population of around 400,000.
He also says that the charity hospitals suffer from a stigma that keeps
privately insured patients away. “Just because we build a new hospital,” he
says, “if it’s still the charity hospital, I question, have you changed the
culture enough that [privately insured] people will start going there?”
Schedler suggests down the road the state will not be able to financially
sustain both a major Medicaid expansion and the continual funding of all of the
state’s rapidly deteriorating charity hospitals. In addition to Big Charity, LSU
is seeking funds to rebuild its aging hospitals in Baton Rouge and Alexandria.
“To try to go rebuild new charity hospitals and do redesign at the same time,
at some point, after three, four, five years the federal government assistance
peels off,” Schedler says. “So how are we going to support both systems? We can
hardly support the system we have right now. You’re in for a collision course.”
With financial issues still a major sticking point, most health care reform
advocates are nonetheless encouraged that the tide of public opinion seems to
have shifted in their favor, and some type of reform seems imminent. “There’s
been a lot of misinformation thrown around about what people think about the
public health system,” says Barry Erwin, president of the nonprofit advocacy
group Council for A Better Louisiana. “There are some politicians who will tell
you, ‘Look, we can’t change it, this is what everybody wants, this is what the
people want. That’s not the case.”
CABL recently commissioned a statewide survey on health care reform, which
found an overwhelming majority of the public, 72 percent, feels the state’s
public health care system either needs reform or complete rebuilding. Erwin says
the survey, which included a high number of uninsured respondents, also
substantiated several flaws in the state’s current system. “People without
health insurance have to wait longer, they have a harder time seeing
specialists, their primary place to receive health care is in the emergency
room, and they have a whole host of issues that the people with insurance don’t
have.
“We sort of knew all this anecdotally already,” Erwin adds. “It’s not a
surprise, but what this does is quantify it and show in a fairly straightforward
way just what that two tiered system is like.”
Erwin maintains Louisiana has traditionally overemphasized various forms of
institution-based care such as charity hospitals, nursing homes or developmental
centers, rather than community-based public health clinics. “We have been an
advocate in the past and continue to be of trying to move away from an
overemphasis on institution-based care in the state versus community based
care,” he says. “We’re generally supportive of the direction that things are
going. The funding is an issue, and there’s still some things to be worked out.
But fundamentally, the direction that they are going, we are supportive of.”
The Independent Weekly Health Care Reform Luncheon
11:45 a.m.
Wednesday, Nov. 29, The Petroleum Club of Lafayette
Participants: State Sen.
Tom Schedler of Mandeville; Gery Barry, president of Louisiana Blue Cross/Blue
Shield; Dr. Anthony Blalock, president of the Lafayette Parish Medical Society;
John Spain, executive vice-president of the Baton Rouge Area Foundation and a
member of the Louisiana Recovery Authority health care committee
Tickets for
the buffet luncheon are $25 per person or $215 for a table of eight; admission
free without lunch. For more info, contact event coordinator Drue Kennerson at
988-4607, ext. 118 or druek@theind.com.