Wednesday, May 30, 2007

PAR's Recipe for a Healthcare Disaster

The Public Affairs Research Council (PAR) has lobbed its proposal for healthcare reform over the transom to little or no public effect. That is probably due to the significant work that LSU and its Health Science Systems did to discredit the biases in the report before it was officially released.

Except when it comes to football, I'm not much of an LSU fan, but in this case I believe LSU did the state a favor. It's not clear that they can run a run-down hospital system, but they know bunkum when they see it. The PAR report is bunkum and deserves to be called such.

With this report, PAR serves as front organization for the Louisiana Hospital Association and Blue Cross/Blue Shield of Louisiana, both of which compete with LSU Health Science's Healthcare Services Division (the former Charity Hospital System).

In a striking case of blaming the victim, PAR cites the hospital system's outmoded physical plant as the justification for dismantling it and — get this — turning most of the hospitals over to local control. Right! The communities with majorities that won't pay for roads, schools or other essential services are going to suddenly find the will (and the revenue) to run a health center focused on providing care for the uninsured? Right! And Dick Cheney and George Bush will apologize for getting us into an illegal and illogical war in Iraq!

The most striking aspect of the PAR report is its complete disregard for the health and well-being of the working poor in this state. PAR wants not only dismantle the public hospital system, it wants to prevent its physical plant from being upgraded, without having any semblance of an idea of how to provide services for most of those people. Oh, well, at least the hospitals (including the privately run hospitals in the state) will improve their balance sheets.

PAR talks wistfully about some kind of insurance plan that would somehow provide coverage that companies will not now offer their workers because either the companies or the employees or both can't afford the so-called coverage. Anyone who thinks compulsory health insurance will work should take a close look at what's unfolding in Massachusetts and other states that have tried to expand healthcare access by giving money to insurance companies without putting more money into healthcare at the public level.

Yet, this is precisely the 'solution' that U.S. Health & Human Services Secretary Mike Leavitt and the consulting company PriceWaterHouseCoopers are recommending for Louisiana. Leavitt admits that his plan will not provide any coverage or any recourse for at least half of Louisiana's uninsured adults.

PAR joins with Leavitt and PriceWaterHouse Coopers in wanting to bet the health of several hundred thousand Louisiana residents on an ideologically driven plan (you know, pretending there is a healthcare 'market') that is failing in states that don't have poverty rates as high as we have here and don't have as high a percentage of uninsured adults as we have here.

Despite these obvious shortcomings, PAR wants to proceed with the dismantling of the LSU Healthcare Services System. Sounds familiar.

It wants to do this just as there is the financial and political will to remedy the major shortfall of at least three of the hospitals — ancient facilities with outmoded equipment. Plans are currently in various stages of development to build new LSU hospitals in New Orleans, Baton Rouge and Alexandria. PAR cites those outmoded facilities as a reason that Medicare patients won't use those hospitals which the report says is evidence that the system must go. But, with new facilities set to come on line, PAR wants to halt those efforts and divert patients from those hospitals into private and non-profit facilities in those regions.

Now, understand that these private and non-profit facilities have for years turned away Medicaid patients and taken Medicare patients only grudgingly because of what the hospitals say are the low reimbursement rates of those programs. Suddenly, these facilities are going to open their doors to the patients they have heretofore tried to avoid. Why does this not add up?

PAR says it wants to develop a magic "the money follows the patient" system of funding as a means to encourage those facilities to take these patients. OK. Here's a test: Show me one place in the country where this is working.

The PAR report reeks of the 'blame Louisianians first' attitude that is so common among the state's elites: the state would be so much better off if only state government was out of the way and we could deal with "those people" the way we want.

Well, these elites have held economic power in Louisiana for the second half of the 20th century and what does the state have to show for it?

We have among the high rates of poverty in the country, thanks in no small measure to a public school system that those elites will not properly fund.

We have the highest percentage of our population in prison of any state in the union and the U.S. has more people in prison than any other industrialized nation.

We have high rates of uninsured adults, when in the rest of the country employer-based insurance is the means that most people get their insurance. That post-World War II system is breaking down nationally but it never really caught on here and has only gotten worse with the decline of unions in our state.

Those elites have successfully fought to prevent any re-investment in the physical plant of the Charity/now LSU hospital systems, aiming for days like now when they could point, as PAR now does, to the poor condition of that physical plant as the justification for dismantling the system.

I know a little bit about this having worked with on the formation of the Louisiana Health Care Authority in the early 90s. That plan called for investment in the physical plant that never materialized. LSU took over the system from LHCA believing they could make a go of its based on its standing as a teaching system. LSU has never received the funding that it said it needed and has never been able to overcome the drag of the aging physical plant on its ability to attract a more economically diverse patient base.

It the streets that would be called a rigged con game. In Louisiana politics today, it's called reform.

Shame on PAR! If it wants to make a meaningful contribution to healthcare reform in this state, it needs to get outside the board rooms and living rooms of its patrons and engage the real people of Louisiana who struggle to provide healthcare for themselves and their families every day.

The fact remains that healthcare is in crisis across the country. As even industry comes to terms with the fact that this country will have to move to some form of a single-payer healthcare plan, that means that it will be the private, for-profit providers who will disappear. We are the only major industrialized country without a single-payer plan and the economic costs we bear because of that are not sustainable from a competitive standpoint.

Nonetheless, PAR is beholden to people who've been trying to shut down the public hospital system in this state for half a century and who are not going to be swayed by the facts now. That's too bad for PAR. They used to be a credible organization.

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