If Jindal’s Got the Job He Wants, Why Is He Still Fighting Health Care Reform?

Governor Bobby Jindal insists that he is not running for president, that he has the only job he wants — that of being governor of Louisiana.

There is a simple way that the governor could prove that: he could order Attorney General Buddy Caldwell to withdraw Louisiana from the suit challenging the new health care reform law, the Affordable Care Act.

Why? Because the Affordable Care Act is good for what ails Louisiana.

Admitting that might not help Jindal’s standing among national Republicans, but there is no better way to prove his commitment to serving Louisiana than dropping a politicized legal challenge to a law that helps Louisiana families and businesses, the health care provider community, and the State of Louisiana. In fact, under Jindal, state government has moved to take advantage of provisions of the new law.

To understand why this law is good for Louisiana, it is necessary to understand the state of health in Louisiana today. Doing so reveals that the Affordable Care Act goes a long way towards addressing what ails health care in this state (and, also, this country).

The Affordable Care Act addresses key things that ail Louisiana and Louisiana’s health care delivery system. It will not only improve access to care in Louisiana, it will stabilize the finances of the provider community and ensure that the state’s health care dollars (spent primarily through Medicaid) get more bang for the buck.

For Democrats, recognizing the state of health care in Louisiana and understanding how the Act responds to what ails it, reveals the blatantly partisan nature of the attacks on the law by Jindal and others. The sound public policy at the heart of the act reveals the efforts to deny Louisiana citizens, businesses and the provider community the benefits of this Act to be strictly partisan and diametrically opposite of the best interests of the state and its people.

Understanding Louisiana’s health care challenges and how the Act responds to those reveals the opponents of the Act for what they are — partisans who place politics above any consideration for the well being of the people of this state.

The Jindal Way: ‘Every Man an Hourly Employee’

In Bobby Jindal’s Louisiana, more people work as cashiers, retail salespeople and laborers than in any other categories of workers. If Jindal had his way, the state’s future will look a lot more like that than, say, the technology and new industry future envisioned by Mike Foster’s “Vision 20/20” (PDF) economic development strategy. (Foster’s strategy was based on an accurate the assessment of Louisiana’s potential, but came too late in his administration to have had a chance to prove itself.)

In Jindal’s personal assessment of Louisiana (informed no doubt by the comments of those many Louisiana businessmen who have handed him campaign checks), our problem is that higher education is not turning out enough skilled workers to satisfy the needs of Louisiana businesses. It’s an odd line of thinking to be held by a Rhodes Scholar biology graduate from Brown University whose adult life has been spent almost entirely as an employee of either the state or federal government.

For some in the state’s business community, converting higher education to a vo-tech program with football teams is a long-held dream.

That perspective gives Jindal the policy justification and political cover for his work of throttling higher education at four-year colleges while proposing that the state’s nascent community college system take up some of the slack — except that he’s cutting them, too. If education was all that four-year institutions did, Jindal’s approach might be more palatable. But, as studies of the economic impact of the University of Louisiana System statewide and LSU’s main campus in Baton Rouge have shown, higher education is big business in Louisiana with a big economic impact on the state as a whole, but especially on the communities where those campuses are located.

University-based research and technology transfer initiatives have been the base upon which strong regional economies have been built in various parts of the country, notably the Research Triangle Park in North Carolina, Silicon Valley in California, and in the Austin, Texas, area. Under governors Mike Foster and Kathleen Blanco, Louisiana finally got serious about pursuing those development models, committing state dollars to build university research capacity and encouraging the development of university infrastructure to attract researchers, research dollars and private sector support.

These are long-term strategies that require patience and persistence, things that do not come naturally to Jindal. The current fiscal crisis and the national campaign cycle have combined to arrest Jindal’s development of these traits.

It took “the intervention at the Mansion” of four of Jindal’s predecessors last year to keep him from inflicting a $220 million cut on higher education. He pared it down to half of that. Now, with the crisis worsening, Dave Treen is dead, Buddy Roemer has gone all Tea Party on us, leaving only Mike Foster as someone Jindal might heed from among last year’s team. Governor Blanco would offer him sound advice, but as Jindal’s governorship is based on being the anti-Blanco the likelihood of him taking it is almost as remote as his chance of being the Republican nominee for President in 2012.

That higher education is going to get whacked was made certain with the appearance of the newest hole in the state’s budget. Faced with what he knew to be a large budget shortfall but mindful of the damage a responsible call for tax increases would do to his national political standing among conservatives, Jindal’s executive budget for the next fiscal year abandons his previous ironclad rule against using one-time spending to shore up the state budget. He wants to grab money from the Tax Amnesty Program and raid various trust funds to avoid more cuts that are already unpopular with voters.

The problem now for Jindal is that he so effectively sold his previous stance that his former allies like the Louisiana Association of Business and Industry and fiscally conservative groups like the Public Affairs Research Council have lined up to oppose him. Even some of his erstwhile allies in the Legislature are aghast at the change of direction.

With the hole in the current fiscal year budget, some of that one-time money might have to be carried back into this year in an effort to avoid late year budget cuts that will force months-long employee furloughs (that is, months without pay!) at campuses across the state, the cancellation of summer school classes, and the halt of construction projects.

Furloughs will have a devastating impact on the families of those working in higher education, ranging everywhere from the administrative level down to janitorial services. People not paid means money taken out of circulation in communities. If bringing jobs to a community has a multiplier effect, taking money out of a community has a negative impact — (a denominator effect?) —that must nearly match that.

The cuts in higher education being contemplated in the last quarter of this state fiscal year (now until June 30) could — by themselves — precipitate what will be known as the Jindal Recession. He will own it because his policies will have caused it.

But, higher education isn’t the biggest sector that Jindal’s policies are wrecking.

That would be healthcare.

The 'Jindal Knows Healthcare' Myth
Saying that Bobby Jindal understands healthcare is like saying used car salesmen understand automobile design and manufacturing.

Jindal earned his chops as Mike Foster’s first secretary of the Department of Health and Hospitals. He earned it by cutting spending in the department, particularly Medicaid spending. His ‘success’ there was so brutal that it cost him the 2003 governor’s race.

Jindal has never understood that behind every government budget dollar there are people dependent on the service that dollar delivers. Nowhere is that more true than in the Medicaid program. Medicaid is a safety net program. It exists to provide access to care for those in our society who cannot otherwise get it, particularly the young, those with chronic disease, and the disabled.

That Jindal made his name by cutting cost in Medicaid is to say that Jindal worked to deny access to services and to care. Yes, he eliminated fraud in the medical transportation program, but the bulk of the savings he found came through a redefining of what services were available and who would be eligible for them. To Jindal, these were just budget numbers. To the people who had them, these were services taken away.

Jindal’s approach has not changed after stints with the Bush administration and in the Congress. He brought in Alan Levine from Florida to manage DHH. Levine came to Jindal’s attention after implementing a managed care pilot project in Florida’s Medicaid program. Levine tried to get the Bush administration to sign off on a similar plan in the final days of that administration, but the plan arrived too late to get approval.

The managed care approach to Medicaid combines Jindal’s indifference to human need with a Bush-era style of crony capitalism. The idea is to reduce the state’s Medicaid spending by bringing in a private sector administrator to run the program that would set limits on the types and frequency of care available to Medicaid patients.

That is, the plan proposes to save money by adding another layer of bureaucracy — a private sector hand in the till — Medicaid spending will somehow magically go down. Think about that for a second. That program manager will be expected to take over administration of the program and save the state money in the process.

The only way that can possibly work is by denying services to those dependent upon the program.

But, as former DHH secretary and current head of LSU Hospitals Dr. Fred Cerise revealed recently, privatization of Medicaid service delivery in the Baton Rouge area is going to drive up the cost of delivery of those services.

This is crony capitalism because the real winners in privatization schemes like this are not the consumers of those services or the taxpayers; the real winners are the companies that win those lucrative contracts. If this sounds familiar, then you were either a victim of the Bush/Cheney era approach to FEMA or read the stories about American reconstruction scandals in Iraq.

All of this is obvious to those now fighting Jindal’s attempt to privatize the homes for the disabled across the state. In a recent legislative hearing on the budget, a parent of a disabled child who is a resident at Pinecrest Supports and Services Center near Pineville plaintively told lawmakers, "I have not heard anything about a better level of care for our family.”

No, because the level of care does not figure into the Jindal Way. It’s not a number. In Jindal’s world, numbers are real; people are not — at least not those who might actually need government services.

Hundreds of state workers who deliver the services at centers like Pinecrest and other state facilities will lose their jobs, undermining the economies of the communities where they reside.

The state’s portion mental health services program will be all but eliminated under Jindal’s proposed budget. The state wants to discharge 118 patients from state-run psychiatric hospitals and place them in privately run group homes. Another 138 beds in state-run facilities would be privatized.

Again, privatization is being pushed as a solution to the state’s budget crisis but privatization has not been shown to be a money-saver nor has it been demonstrated that the quality of care will not be affected by the changes.

Next Year, We Take Down 'Charity'

Jindal is committed to taking this a step further in their next budget when he wants to develop and implement a plan to shut down much if not all of the LSU Hospital system (formerly known at the Charity Hospital System).

This has been the long-cherished dream of conservatives and it will be presented as a budget necessity. But, it is nothing but a naked ideologically driven move designed to prop up Jindal’s conservative credentials. The closure of these hospitals has been Jindal’s goal all along. Jindal is now citing the impact of the Affordable Care Act as the justification for the move he craves to make. Jindal says the problem is that the Affordable Care Act will do away with the Disproportionate Share Program of compensating hospitals for providing care to the uninsured.

True enough, but the Affordable Care Act will bring coverage to 800,000 Louisiana adults (PDF)who do not now have coverage so that there will be fewer people without insurance coverage or the ability to pay for care.

In fact, the Affordable Care Act will bring $17 billion in new healthcare funding annually into Louisiana through a combination of tax credits to businesses, subsidies to individuals, and expansion of the Medicaid program. If anything, Louisiana will need more medical capacity, not less.

Typical of an ideologue, Jindal is committed to a course of action and he’s not going to let the facts stand in his way.

When the Revenue Estimating Conference makes their official end of the fiscal year deficit estimate next Wednesday, all of Louisiana will get a much clearer picture of just how far down Jindal is willing to push this state in order to attempt to continue his political climb.

Get ready to feel pretty low on the totem pole, Louisiana.

Democratic Louisiana: "It Started With Jindal's Stelly Flip"

This article is "The Big Blue One" from Volume 1, Number 1, of Democratic Louisiana, a Louisiana d2d project.

Repealing the income tax portion of The Stelly Plan was not on Bobby Jindal’s agenda when he became governor in 2008, but as sentiment in the House grew for repeal, the new governor moved to leap in front of the parade that championed the repeal.

Under the Stelly Plan, which was approved by state voters in 2002 while Mike Foster was governor, the state sales tax on food for home consumption and the sales tax on natural gas, electricity, and water for residential use was lowered on January 1, 2003, from 3.9 cents to 2 cents per dollar. Taxes on those items were then eliminated on July 1, 2003. To replace revenue lost through Stelly, individual income tax brackets were adjusted upward.

The plan was not popular with those in the top two state income tax brackets where individuals paid up to $500 more in taxes each year.

In the 2007 statewide elections, Jindal romped to a primary win over a fragmented gubernatorial field and Republicans picked up significant representation in both the state House and Senate.

During the 2008 regular session of the Legislature, Jindal first opposed the repeal of the income tax provisions of the Stelly plan because of the loss of revenue would be too steep (about $358 million per year). Sensing the political momentum and not wanting to disappoint his conservative backers, Jindal flipped on the issue and endorsed the repeal. With the new governor’s backing, repeal passed easily. And Louisiana was sent careening down the road towards a financial crisis.

It did not take long for trouble to appear.

In December of 2008, the state discovered that it had a projected budget deficit for the 2008-09 fiscal year that nearly matched the cost of the Stelly repeal, dollar for dollar: $341 million.

The repeal of the income tax portion of the Stelly Plan is a mistake that keeps on giving as it deprives the state of significant revenue each year. Viewed another way, counting the budget proposed by Jindal and now being considered by the Louisiana Legislature, the repeal of the income tax portion of the Stelly plan has cost state government more than $1 billion dollars in revenue it otherwise would have had to meet rising need.

The Jindal Way: Afflicting the Afflicted

What rising need? The Louisiana Budget Project (LBP), a non-partisan arm of the Louisiana Association of Nonprofit Organizations, monitors and reports on state government spending and how it affects the Louisiana’s low- to moderate-income families. In LBP's review of Jindal’s 2011 Executive Budget ("Louisiana's Fiscal Crisis"), the organization notes,

“between January 2005 and January 2010, families using food stamps increased 20 percent. Medicaid enrollments increased 13 percent from pre-Katrina levels. The number of enrolled students at four-year institutions increased 3 percent between 2004 and 2009, from 214,144 to 220,381. At community colleges, enrollment increased 37 percent during the same time period, from 50,920 to 69,940. The state’s unemployment rate increased from 5.4 percent in December of 2004 to 7.3 percent in December of 2009."

Yet, confronted with these growing demands, Jindal has steadfastly refused to take any step to increase state revenues. Why? Because agreeing to increase taxes or fees would damage his national prospects among conservative Republicans whom he has courted assiduously since his election.

Jindal’s resistance to raising taxes or seeking other ways to raise revenue combined with the fact that healthcare and higher education are the only areas of the state budget not constitutionally protected from cuts has produced a budget balancing approach best summed up as “comforting the comfortable and afflicting the afflicted.”

Jindal’s calculation appears to be that he can build campaign for president (“The Louisiana Way” branding of his budget approach and the upcoming book some one wrote for him) on the backs of Medicaid recipients and providers and those in higher education.

Had the status quo held that might have been possible. But, as everyone knows, Louisiana’s economy has been floating on a sea of federal disaster dollars since the storms of 2005 (with more injected after the storms of 2008). That money is beginning to taper off. The LBP says federal dollars accounted for more than half of the state’s budget in 2009-10, and that will drop to 45% in the current budget.

And, with Jindal’s Republican colleagues in the Congress fighting to stop even the extension of unemployment benefits, the likelihood of additional federal economic recovery dollars is uncertain at best. The potential loss of those dollars is what sparks the talk of Louisiana’s budget going “over a cliff” next year.

That has forced Jindal to try to deny the undeniable (the state needs more revenue) by attempting shift program costs onto local governments, particularly local public school systems.

Jindal’s Blind Spot: Services Are Delivered By and Go To People

But, behind every number in a state budget is a human story. Dating back to his days when he was wrecking the public health network as Mike Foster’s secretary of the Department of Health and Hospitals, the evidence is that Bobby Jindal has never understood this basic fact.

And here is where Jindal’s anti-tax fanaticism is inflicting its greatest toll on the state.

Jindal’s budget cuts, particularly in Medicaid, reduce access to care for the poorest among us. Medicaid provides access to care for children, pregnant women and the disabled. Medicaid is a huge program in our state and Jindal and legislators have found making cuts there relatively easy because of the size of the program. Medicaid is an insurance program. It does not give money to patients, it pays for patient care by paying providers — doctors, nurses, hospitals — for that care. The reason providers are turning away Medicaid patients is that the state of Louisiana keeps cutting the amount of money they will pay those providers to give that care.

So, Medicaid budget cuts impact not just the poor and the disabled, they also impact the healthcare provider community. The Louisiana Hospital Association (LHA) said Jindal’s proposed budget 2009 cuts would have cost nearly 2,000 healthcare jobs in our state. The final budget last year lessened those cuts, but subsequent deficit projections and cuts have brought additional compensation cuts, which are driving cutbacks in clinics and hospitals across the state.

Jindal’s budget cuts are wiping out good paying jobs across Louisiana. Yes, he is reducing the number of state employees, but Medicaid cuts are costing the state thousands of healthcare jobs each year and the cuts in higher education are shutting down programs, costing hundreds of instruction and support jobs, and sending research dollars out of the state that otherwise would have come here. At the K-12 level, Jindal is trying to push costs down to local school systems and eliminating programs intended to improve the performance of students in the critical early grades.

Compounding the error are recent revelations that outsourcing of state services particularly in the areas of health and social services will actually drive up the cost of operating those programs, and it is clear that Louisiana is merely a prop for Jindal’s political posturing on the national political stage.

Louisiana is historically a low-wage state. The jobs that Jindal’s cuts are forcing in healthcare, higher education and K-12 are not jobs that will make people rich, but they are good jobs that support middle class families and that have a high probability of including benefits packages for the people holding them.

And while Jindal saved 1,300 or so low-wage jobs in Union Parish by subsidizing the purchase of a bankrupt chicken plant, his cuts are forcing far larger losses of better paying jobs in the public and private sectors.

Bobby Jindal is sacrificing those good Louisiana jobs at the altar of his national political ambition.

Coming Friday: “Jindal’s Way: Economic Carnage”

(Blue) Dog Whistles

Dah-yum! Says here that the so-called Blue Dog Democrats are raking in political contributions from the pharmaceutical, health insurance and health insurance industries.

McClatchy's Washington news bureau has the shocking news:

As the Obama administration and Democrats wrangled over the timing, shape and cost of health care overhaul efforts during the first half of the year, more than half the $1.1 million in campaign contributions the Democratic Party's Blue Dog Coalition received came from the pharmaceutical, health care and health insurance industries, according to watchdog organizations.

The amount outstrips contributions to other congressional political action committees during the same period, according to an analysis by the Center for Public Integrity, a nonprofit watchdog organization. The Blue Dogs, a group of fiscally conservative lawmakers, successfully delayed the vote on health care overhaul proposals until the fall.

The article continues:

On average, Blue Dog Democrats net $62,650 more from the health sector than other Democrats, while hospitals and nursing homes also favor them, giving, respectively, $5,680 and $5,550 more, according to the Center for Responsive Politics, a nonprofit organization that tracks the influence of money in politics.

The contributions came at a time when health care and pharmaceutical companies were mounting a campaign against a government-run public health insurance option, fearing cost controls and an impact on business. The Blue Dogs' windfall also came at a time when the 52-member coalition flexed its muscle with both the White House and the Democratic leadership in the House of Representatives as an increasingly influential bloc in the health care overhaul debate.

With 'friends' like these, who needs Republicans?

Well, at least the those same interests view the Republicans as more reliable votes, based on the money they give them:

House Republicans, however, tend to collect more than Democrats — including Blue Dogs — from insurers, health professionals and the broader health sector, the Center for Responsive Politics found.

I consider myself a loyal Democrat, but I am sick and tired of supporting Democrats who go to Washington (and Baton Rouge) and vote like Republicans on issues that matter to me. Healthcare reform is a signature Democratic issue and has been since Harry Truman tried to pass universal healthcare back in the late 1940s.

If these Blue Dogs can't bring themselves to stand with their party and their president on this core issues of our party, the question that must be asked is this: "Why are they members of this party?"

If their loyalty is to their corporate fund-raisers and not to the hard working people in their states and districts who are struggling to afford health insurance and/or to avoid losing everything they have in order to pay medical bills, why don't they align themselves with the party that makes no pretense about their loyalty to the rich and the powerful?

There is a party that welcomes people who think and vote that way.

The Democratic Party is not it.

We have a party primary system in place for federal elections in Louisiana. Those primaries should be used to remind Democrats who have apparently gone soft headed running in open primaries that there is a loyal Democratic base that cannot be taken for granted or ignored.

We matter. We volunteer. We work in campaigns. And we vote.

Speakout for the Public Option

AMA backs the Public Option. Why can't Mary?

The American Medical Association (AMA) — GASP!!! — has endorsed the healthcare reform legislation proposed by Democrats in the U.S. House of Representatives according to the Associated Press:

The American Medical Association on Thursday endorsed a liberal health overhaul bill that includes a public insurance option, a bold step for a traditionally conservative group with a checkered past on health reforms.

In its strongest action yet signaling support for President Barack Obama's vow to reform health care, the nation's largest doctors' group sent letters to three House committees behind the bill. The letters, signed by AMA's executive vice president, Dr. Michael Maves, said the AMA appreciates and supports what is being called America's Affordable Health Choices Act.

This is an historic shift. The AMA opposed the introduction of Medicare and Medicaid in the 1960s. It's conference of delegats gave President Obama a lukewarm reception when he addressed their convention earlier this summer.

The AMA's leader told the news organization that the fact that the Democratic proposal will bring healthcare coverage to the 50 million Americans now without health insurance was what won the organization's support:

Dr. J. James Rohack, AMA's president, told The Associated Press that the group's endorsement shouldn't be seen as the AMA turning more liberal.

"It's not blue or red, or Democratic or Republican. This is something that is the AMA's core values," Rohack said. "The status quo that is 50 million Americans not having health insurance, a system that has administrative waste and as a result drives up premiums so that it is unaffordable for many patients — that is just not acceptable."

The AMA has long believed any health system reform can be achieved by revamping private health insurance plans. It fought the creation of Medicare and succeeded in delaying its debut decades ago. That was when it had more clout; its membership has dwindled to include barely one-fourth of the nation's doctors.bama a lukewarm reception earlier this year when he addressed their convention.

So, the AMA has endorsed the House Democratic proposal with the Public Option — a provision that will allow working age Americans to buy into a Medicare-like public insurance program.

Wonder what is keeping Senator Mary Landrieu from seeing the light on this? Maybe this has something to do with it.

Calling Senator Landrieu!

The Service Employee International Union (SEIU) is continuing to work in support of the public option in healthcare reform.

This graphic says it all.

Healthcare Costs Bankrupt Even Those With Health Insurance

The New York Times reported on Tuesday that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured."

This is scary. Why?

Because more than half of all bankruptcies (prior to the current economic bust) were related to healthcare expenses. You can read the report on this fact here (PDF).

If you do the math (61% of all bankruptcies involve medical expenses; 75% of medical expense bankruptcies involve people who HAD health insurance), you'll find that somewhere around 40% of all bankruptcies involve medical expenses of people who had health insurance.

"Underinsurance is the great hidden risk of the American health care system," Elizabeth Warren told the Times. She co-authored the 2007 report on healthcare bankruptcies cited above. “People do not realize they are one diagnosis away from financial collapse.”

The Times reports:

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

To put a human face on the issue, the Times tells the medical tale of woe of Lawrence Yurdin, a 64-year old computer specialist living in Texas. To make a long story short, Mr. Yurdin faced tens of thousands of dollars of unexpected medical expenditures if he got necessary heart procedures, even though he had health insurance coverage.

Things turned out well for Mr. Yurdin, though, the Times reports:

But as of Wednesday, his future insurance problems are largely solved: he qualifies for Medicare because he turns 65.

The "public option" in President Obama's healthcare reform package would allow working age Americans (18-64) buy into a Medicare-like program that would provide medical coverage (as does Medicare) with affordable premiums.

This is the plan that the health insurance companies (you know, the ones who deny coverage and have overhead costs that consume about 30 percent of health insurance premiums) are opposing.

There are tens of thousands — if not millions — of stories like Mr. Yurdin in America today. There are tens of thousands — if not millions — of stories involving people who cannot even afford health insurance premiums.

Recent polls show something on the order of 70% support for the public option in the country, fueled in no small part by the direct experiences individuals, families and businesses have had dealing with private, for-profit health insurance providers.

Senator Mary Landrieu has not heard from enough Louisiana residents who want this public option as a path to affordable access to care. Call her office and tell her you support the public option!

Here's a list of her in-state offices:

New Orleans Hale Boggs Federal Building
500 Poydras Street
Room 1005
New Orleans, LA 70130
Voice: (504) 589-2427
Fax:(504) 589-4023

Baton Rouge Room 326, Federal Building
707 Florida Street
Baton Rouge, LA 70801
Voice: (225) 389-0395
Fax:(225) 389-0660

Shreveport U.S. Courthouse
300 Fannin Street
Room 2240
Shreveport, LA 71101
Voice: (318) 676-3085
Fax:(318) 676-3100

Lake Charles
Hibernia Tower
One Lakeshore Drive
Suite 1260
Lake Charles, LA 70629
Voice: (337) 436-6650
Fax:(337) 439-3762

She needs to hear from you!

Why Louisiana Needs Healthcare Reform

The debate on healthcare reform is intensifying in Washington and across the country. This is not a debate taking place in the abstract.

Louisiana stands to benefit greatly from reform — if the final package includes the so-called "Public Option." The public option is a proposal by President Obama to offer working-age Americans the opportunity to buy health insurance coverage similar to coverage currently available to those over 65 through Medicare.

Health insurance companies oppose this, saying that the government will ultimately drive them from the field; that they won't be able to compete. The public, according to polls, is not buying that argument. Various polls report public support for the public option to be running 70 percent and higher.

That probably has something to do with the experiences those with insurance have had with insurance companies over the years. The insurance companies have not endeared themselves to the American public through their arbitrary denials of coverage, refusal to pay claims, and general ripping off of consumers and businesses over the years.

The case for reform is becoming still more urgent in Louisiana coming on the heals of a disastrous (for providers and patients; analysts say the Governor did well) legislative session for healthcare. Medicaid is a big-ticket, unprotected item in the state's budget and the poor have no well-healed army of lobbyists to work the Capitol for them. As a result, the only opposition raised to a quarter billion dollars in Medicaid cuts were hospitals who will lose money through reduced reimbursements.

And, while the initial pain will fall squarely on the poor, ultimately those of us with health insurance will pay for these cuts, as hospitals and other providers shift costs onto those with coverage to recoup the lost dollars resulting from the state budget cuts. Oh, there is also the matter of the thousands of healthcare jobs that will be lost as a result of these cuts. But, it's all good because taxes were not raised and the Governor's presidential ambitions remain in tact.

Healthcare reform on the national level, specifically the public option, holds real promise for Louisiana. First, Louisiana has historically had a large percentage of working age people without health insurance coverage. The latest figures are that only 54 percent of employers offer any form of coverage. In many small communities across the state, local governments offer coverage for their workers but the workers can't afford to pay the premiums based on the small salaries they receive.

The public option will bring competition to insurance markets. In Louisiana, there is not much competition. Blue Cross has 61 percent of the market. Combine that with the second largest health insurer and 74 percent of the market is owned by those two companies. Introduction of the public option would immediately bring cost discipline to the health insurance markets that is sorely missing now.

You can find these and other great facts about the current state of healthcare in Louisiana here.

Any requirement to force companies to offer health insurance or to require individuals to buy health insurance coverage without the inclusion of a public option is nothing more than a gift to the very companies that have produced this financially ruinous system that is responsible for at least half of the bankruptcies in the U.S. each year.

The public option is the minimal requirement for any program worthy of the name healthcare reform.

Senator Mary Landrieu needs to know that Louisiana voters support the public option. So far, only her insurance company lobbying friends are getting through. Call her office. Remind her that you have stood with her and now you expect her to stand with you in support of the public option.

The public option will be good for us, good working Louisiana families, and good for our country.

Health Execs Propose Ripping the Safety Net

The Times Picayune puts it a bit more delicately, but make no mistake about it this proposal (variations of which have been around for as long as there have been private, for-profit hospitals in Louisiana) is an ideology-driven attempt to tear the last vestiges of Long-ism (read that "paying attention to the needs of working people") from Louisiana.

Were that all there was to this, it would be a hell of a fight. But, the proposal being floated by these healthcare executives — and, by the Bush administration in the months immediately following Katrina/Rita, by the Public Affairs Research Council (PAR), and the Blueprint for Louisiana group — comes to the fray with the additional burden of having been discredited in other states where similar approaches have been talked about and even tried — primarily Massachusetts.

The core issue is shutting down the LSU Health Science Center hospitals, formerly known as the Charity Hospital System (also known as the safety net hospitals). And, then "letting the money follow the patient" — right into the coffers of the very people who have made healthcare and health insurance too expensive for all but the wealthiest among us: the for-profit hospitals and the insurance companies.

More for Less

The Healthcare Execs trot out the familiar refrain to those who have been watching/involved in the various attempts to reform healthcare here for the past three decades: "we can provide better care for less money."

This is precisely the argument that Buddy Roemer's Louisiana Health Care Authority made in getting the Legislature to take the Charity System away from the Department of Health & Hospitals back in the early 1990s.

When that did not work, LSU came along in the Mike Foster administration and said that they could run the system without burdening the state because they could operate the hospitals as teaching hospitals and take advantage of some federal payment rules to rebuild the hospitals and provide better care without the state having to subsidize the hospitals. That hasn't worked out as billed, either, primarily because neither the LHCA nor LSU HSC could get the money to replace the aging infrastructure of that system.

Now come the Healthcare Execs making a similar pitch except that they don't want to save the LSU HSC hospitals; they want to destroy them. Then, they say that if the state will give the insurance companies AND the hospitals money, and mandate health insurance coverage they will provide care for at least some of the patients they routinely refuse to treat now — the uninsured and Medicaid patients.

The trickeration here is evident when the Healthcare Execs say they will do all this AND save the state money. These guys have nothing on Don King!

One of the key facts to understand about healthcare is that is an extremely large and extremely inefficient industry. Estimates are that overhead in healthcare accounts for 31 percent of the cost of all healthcare provided in the United States. Now, that is a huge chunk of change when you consider the fact that we spend in excess of $6,000 annually on healthcare per man, woman and child in this country. We are talking annual spending in the range of $2,000,000,000,000 (that's $2 Trillion!). Plug in the 31 percent figure and the overhead on that bill comes in at more than $600,000,000,000 ($600 Billion!) annually.

It is important to understand what accounts for this overhead. Yes, there are the very real costs of moving and storing the massive amounts of paper that the industry generates. There are the excessive tests. There are all the expensive diagnostic and treatment machines and technology. There are also things like financing the debt from the various sales and buyouts of large healthcare companies like HCA. There are the penalties and fines that private sector healthcare providers like Tenet (1, 2, 3), HealthSouth and others have had to pay in order to resolve, er, uh, billing issues involving Medicare (never admitting any wrong doing, of course). Then there are the absolutely fabulous salaries paid to the executives of the private healthcare companies.

The 31 percent overhead figure applies to all healthcare. However, when the focus is on public-sector healthcare, a far different picture emerges. The Veterans Administration, for instance, operates with only a one-percent overhead, delivering world class healthcare to veterans across the country (using a public domain electronic medical record system — VistA — that it developed itself and which is now being used in many healthcare operations in other countries). Imagine how good the care provided by the Veterans Administration would be if it were adequately funded!

So, what these 'reformers' — PAR, the Blueprinters, Healthcare Execs, et al — are proposing is preposterous on its face.

They propose allowing the most inefficient healthcare players in the state drive the relatively efficient (but badly under-funded) public hospitals out of business; then bring their partners the insurance companies into the game and allow them to dip their hands into the healthcare finance stream; and provide care to the patients they will not take now for less money than they are willing to accept from Medicaid and Medicare! Could they pull this off, it would rival the miracle of the fishes and loaves!

Follow the Money

But, this plan is not about healthcare. It is, instead, about diverting public finance streams into the pockets of private companies (sounds suspiciously like FEMA and Iraq, doesn't it?). These folks don't care about the uninsured. They don't care about most of the people on Medicaid — although, delivering babies and providing pre- and post-natal care is apparently a great money machine for some companies. HCA's Women and Children's Hospital in Lafayette is a Medicaid money mill, drawing women from across the region. What they care about is the money. And, any plan that proposes delivering more care for less money using the most inefficient (is "greedy" too strong a word?) delivery mechanism around is a prima facie scam!

But, the people pushing this plan are desperate. In late summer, a Wall Street analyst predicted that Tenet would be bankrupt within three years. HCA is loaded with debt following its being taken private by the family of former U.S. Senator Bill Frist and some of the companies being dragged down by the current credit crisis resulting from the housing bubble.

Servicing the debt load of these companies is figured into the charge for every service delivered in those facilities, contributing to the high overhead in those private-sector providers.

Dr. Fred Cerise ran DHH for most of the Blanco years and negotiated with the Bush administration over the first attempt to force a variation of this plan down the state's throat in the wake of Katrina/Rita. He told the Times Picayune the plan is smoke and mirrors:

Dr. Fred Cerise, the LSU system vice president for health care and medical education, disputed the coalition's conclusion that the state has enough money to provide coverage for all adults earning less than 200 percent of the poverty mark -- especially if the program is expanded beyond the 80,000 adults in the New Orleans are to the entire state.

Cerise said the disproportionate share hospital payments that sustain charity care in New Orleans amount to a small fraction of the $19 billion consumers in Louisiana spend on health care every year, and they were not enough to bankroll insurance coverage for thousands of adults.

"The expectation that you are going to provide general access to the uninsured population with less than 3 percent of the total health care dollars is just unrealistic," he said. "The premiums in the plan are about half of those in a conventional plan. If premiums are that low, they are not providing a full range of services and will rely on the safety net still being present."

At a recent meeting of healthcare leaders in New Orleans, Republican Representative John Labruzzo rattled off a list of LSU HSC hospitals that he said would be closed, including Lake Charles, Lafayette, Independence and Bogalusa. There may be others, including Pineville.

Reading from the same page in the Book of Ideology, the Blue Print Plan included a proposal to turn these hospitals over to local communities which would be the equivalent of closing them. I'm certain that this idea had its roots in Lafayette where such a plan has been bandied about by the folks competing with University Hospital for some time.

The idea is ludicrous on its face. We can't get local support for taxes to update badly needed public schools and roads — and these elites want to put the fate of the safety net at the back of those lines? They know what the implications of their recommendations are; this will kill those hospitals.

The Crisis Is Not Local

What PAR, the Blue Print and now the Healthcare Execs choose to ignore is that healthcare is in crisis in all of the United States — not just Louisiana. By trying to make Louisiana's healthcare delivery system look like the rest of the country, these so-called reformers are trying to force the state to conform to a model that is every bit as flawed as they one they want to replace.

That the reformers and the Healthcare Execs won't let the facts deter them from their mission confirms that they are, indeed, from Louisiana. It also demonstrates that their efforts are not about healthcare, nor about the safety net. Nope, it's all about 'the Benjamins.

To show how rapidly perceptions about healthcare are changing across the country, the American College of Physicians (124,000 members) this week called for the need for universal health coverage and said that a single-payer plan may be the only way to get there.

With new LSU HSC hospitals slated to be built in New Orleans, Baton Rouge and Pineville, these facilities will be able to compete not just for safety net patients, but even for Medicare patients. This is what frightens the Healthcare Execs. There has been a decades-long struggle to strangle the public hospital system in Louisiana by denying it the ability to renew its physical plant. In the wake of Katrina/Rita, the dollars to rebuilt a significant segment of that system are available — Governor Kathleen Blanco and the Legislature saw to that.

This push must be seen for what it is — a pre-emptive strike against those new hospitals (particularly in New Orleans) before they can become competitive with those private sector hospitals. It is also a blatant grab for the green that flows into Louisiana in the form of Medicaid dollars. PAR conceded in the spring that it's plan (subsequently adopted by BluePrint) would offer no solution for as many as half of Louisiana's 900,000 uninsured adults between the ages of 19 and 65.

The plan being pushed by these Healthcare Execs is an attempt to create a safety net for hospitals while the state would abandon the mission of providing care for hundreds of thousands of Louisiana citizens. Nonetheless, the Healthcare Execs and the so-called reformers want to destroy the safety net in order to enable them to tap into that federal money stream before the country decides it is time to move to a single payer plan.

Jindal's Test

We are in the gloaming of the 'Jindal as an idea' period now. The Jindal administration still exists more as an idea than a reality. With each passing day, we get closer to that reality and the policies it will bring.

It will also bring with it the necessity of Jindal ending the coy dance about who he is and what he stands for. Those games will end soon and the Governor-elect will have to learn to deal effectively with the Legislature and live up to the standards which he's set for his administration.

If he can't do that, he need look no further than Buddy Roemer's brief tenure as a guide to the fate that awaits him. Democrats and all people interested in preserving access to healthcare and the safety net institutions need to engage in this battle. More than ethics, the coming battle over the shape of healthcare is going to determine the fate and duration of the Jindal administration.

The Louisiana Democratic Party fell on its face in this year's elections because the party didn't give people a reason to turn out to vote; it didn't stand for anything. As a result, it flailed about doing stupid things like attacking Bobby Jindal's religious views (and poisoning the well for Catholic candidates in north Louisiana, including Democrats).

Healthcare policy is going to be front an center in the Jindal years — as it should have been in the elections. Democrats can prove that they stand for something by protecting the healthcare and social service safety net — and holding the new administration to account when they try to shred those essential services.

Stand for something, or fall for anything.