So What are the Chances for Real Health Care Reform?
May 1, 2006 CABL Briefing
It was an interesting week when it comes to health care reform in Louisiana—one that, if nothing else, shows how difficult the prospects for real reform might be. It began on Tuesday when U.S. Health and Human Services Secretary Michael Leavitt spoke to two legislative health panels. He was direct and to the point. In Louisiana: 1) a mediocre health system was washed away, 2) it would be wrong to build back that old system, 3) but the state has an opportunity to create a system that can become a national model. He challenged state leaders to develop a bold plan that would transform health care delivery. If we do, he said, he would support it with money and other federal resources.
Fast forward two days later. On Thursday the Louisiana Recovery Authority’s Health Care Task Force heard the first public presentation of a study the LRA’s own support foundation commissioned from the nationally recognized consulting firm PricewaterhouseCoopers. The 244-page report indeed included a series of bold recommendations that would transform health care delivery in the state. What happened? The debate over whether and how to “receive” the report took longer than the consultant’s presentation, and task force members spent no time discussing the substance of the findings. You could almost see the gears of the status quo trying to grind major reform to a halt.
Granted, no one would have expected the task force to endorse a voluminous report they were just presented, but the fact that so many members went into defensive mode so quickly is a sign that bringing transformative health care reform to Louisiana—no matter how urgently needed—is going to be tough.
The consultant’s report is pretty clear about the state of Louisiana’s current health care system. It says our system suffers from high cost and lower than expected quality. It points out that health care in Louisiana has evolved into a polarized two-tiered system that is detrimental to the health of all citizens. And it suggests that while many studies have been undertaken and published, few systemic changes have occurred. Sound familiar?
In responding to this situation, the report makes 15 recommendations. The highlights include:
Eliminate our two-tiered public and private system and transform it into one system that serves all the citizens of the state.
Target federal health care dollars to patient services—not facilities. Under this mechanism health care for the poor doesn’t depend on public hospitals. Instead, the state would contract services in a region to whatever entities can best provide the care. The future of public hospitals would depend on their ability to compete with private providers based on objective, quality-focused criteria.
The charity hospital in New Orleans should be rebuilt smaller in conjunction with the new Veterans Hospital already authorized for the area. It should focus on niche areas of national excellence, research, teaching and a Level 1 Trauma Center.
Because of shifting population, a new public hospital should be built in Baton Rouge to replace the aging Earl K. Long Hospital. It would include a Level 1 Trauma Center and an expanded role for training new doctors.
LSU should continue to manage what would be the three major “teaching” hospitals in New Orleans, Baton Rouge and Shreveport, but divest its management responsibilities from all others around the state. Again, their survival would depend on their ability to compete with other institutions in their regions.
Clearly, these are bold recommendations and controversy is to be expected. But at the same time, the recommendations strike a familiar chord. They sound a lot like what many in the state have been saying for years. It should give us confidence that a major consulting firm like PricewaterhouseCoopers validates many of the ideas that others in Louisiana have already put forward.
Because this is complex, it makes it so much easier for defenders of the status quo to nickel and dime the recommendations with obstacles and block reform just as they have done in the past. But things have changed.
That’s why the consultant’s last recommendation should really stick with us: “Because this report calls for systemic rather than piecemeal change, strong leadership and resolve will be necessary to achieve the vision of health care quality for all Louisianans.” That’s the bottom line: leadership and resolve. Do we have it? We’ll see.