By Daniel T. Smith
The Alexandria Town Talk ran an article this week about the proposal to rebuild the Huey P. Long Medical Center, which is part of the state’s network of charity hospitals. Nearly $13 million has been marked for the project in the state budget. State Rep. Israel B. Curtis (D-Atown) explains that because the source for the funding has yet to be determined, the fate of the proposal lies in the upcoming legislative session.
The future of Huey P. Long brings home a statewide debate on reforming health care, which has focused primarily on a saga of political wrangling in New Orleans and Baton Rouge. Last week, Governor Blanco made headlines when a consulting company she contracted released the most ambitious plans to date for a joint VA/LSU medical complex in downtown New Orleans.
In its most recent form, the proposed LSU training hospital would replace Charity and University Hospitals with a $1.2 billion 484-bed medical complex, which would include a trauma center and top-notch facilities for neurosurgery and orthopedics. In addition to providing basic care for the uninsured, the plan calls for a state of the art hospital large enough to attract more insured (and thereby paying) customers. The hospital could pay off its cost, $400 million of which comes from federal funds ($300 million of Community Development Block Grants has been set aside by Blanco’s Louisiana Recovery Authority).
LSU currently administers the network of charity hospitals in Louisiana, including the Huey P. Long Medical Center in Central Louisiana. In order to save money on administrative and facility expenses, the LSU hospital would be built adjacent to a new VA Hospital in what would become the cornerstone of a revitalized medical center in Orleans Parish. $600 million federal dollars have already been approved for a VA hospital.
Obstacles and opposition to building the new facility are widespread. Republican U.S. Senator David Vitter wants hundreds of millions of Medicaid dollars, which previously went to Charity Hospital, to instead be used to purchase private insurance for the uninsured. This would open them to seeking medical services from private hospitals. Small businesses that do not offer employee health insurance could also have to pay into the system.
Senate Health and Welfare Committee head Joe McPherson (D-Wordworth), who has filed a bill (SB 1) to steer the uninsured to government managed health care focused on prevention and primary care, believes that Vitter’s plan would cost the state an extra half billion dollars per year for the New Orleans area alone.
Moreover, as CEO of the LSU Health Care Services Division Donald Smithburg points out, the new hospital does not follow the mistakes of the past:
LSU has repeatedly and emphatically declared that it has no plans to construct and operate the new hospital using the old charity system model. On the contrary, LSU strives to create a 21st century academic medical center to support its mission of patient care, medical education, trauma services and furthering research. We will do so in a cost-saving partnership with the VA, which already has its funding appropriated through Congress.
Any verifiable health reform that truly helps small business and the uninsured citizens of our region will complement a teaching hospital, which will always be an anchor of New Orleans health care.
Senator Vitter said the new LSU training hospital would be “a proposed very big charity that costs 12 times more than any previous estimate,” a clear hyperbole for which he has been taken to task by the Daily Kingfish.
U.S. Rep. Richard Baker (R-Baton Rouge) opposes the hospital complex in downtown New Orleans on the grounds that the state might use eminent domain as a last resort for securing land for the hospital.
The Bush Administration has long been against a federal partnership for a charity hospital in downtown New Orleans. Bush’s Secretary of Health and Human Services Mike Leavitt has called for replacing the Louisiana charity hospital system with private insurance vouchers. Some see the old system as ineffective (Huey P. Long was instructed to make improvements as late as 2003, but in 2006 it was found to have satisfactory standards).
On the other hand, Louisiana Health and Hospitals Secretary Fred Cerise
said the insurance model won’t work unless the state fixes the underlying health-care delivery system. Prior to Hurricane Katrina, the New Orleans area had far too many doctors and hospital beds, one reason its private-sector health care system had the highest costs and worst quality outcomes in the country.
Sparring between the federal and state governments, and between the LRA and the Louisiana Legislature (which decided to authorize the full $300 million of CDBGs before it didn’t before it did again), led Governor Blanco to state, “These administration games over the Leavitt plan could cost the people of southeast Louisiana a golden opportunity.” This was near the time it became known that the VA was beginning to consider other areas.
Over a month ago, U.S. Rep. Jeff Miller (R-Florida) began to publicly suggest that the New Orleans Veterans Hospital should be relocated to western Florida. Department of Veterans Affairs Secretary Jim Nicholson repeated the VA’s commitment to the Greater New Orleans area, but
Asked if he was looking at sites outside the downtown area, where Louisiana State University wants to build its proposed hospital, Nicholson said, “We are going to be. We are putting out a request for proposals to look at sites that might be suggested to us to look at.
As the Louisiana Weekly points out, “to look at sites that might be suggested to us to look at” probably means Jefferson Parish. Collaboration between the VA hospital and an LSU training/charity facility could be accomplished in any number of ways, and the Department of Veterans Affairs doesn’t seem to care whether the two hospitals are even in the same area of Greater New Orleans.
The Public Affairs Research Council of Louisiana has written that the state should strive to determine the hospital’s size and relationship with the region’s private medical sector.
In addition to David Vitter, organizations like The Louisiana Hospital Association and the Metropolitan Hospital Council are opposed to rebuilding a large charity hospital in New Orleans, presumably because the proposed public medical complex aims to attract a larger number of private hospitals’ paying customers than ever before. U.S. Rep. Bobby Jindal (R-Metairie), who worked in state health care for former Governor Mike Foster, has vowed to stay silent on the issue until after the legislative session ends this summer. Another organization, the Coalition of Leaders for Louisiana Health Care (of which Ochsner is a part), has been working on a proposal based on the suggestions of Leavitt and Vitter. Like Jindal, it too will not be ready to speak until sometime in June.
McPherson has expressed skepticism over the motives of a coalition of businessmen and politicians who are joined in opposing the hospital:
I don’t think a congressman or a legislator or an insurance salesman should be dictating what kind of new hospital should be built. That’s a job for experts in the design and engineering field on the advice of expert consultants.
Senate President Donald Hines (D-Bunkie) agrees. “There might be a strong desire for some of them to get their hands on the money and maybe outcomes are not their top priority.”
The upcoming legislative session holds the future of not only the Huey P. Long and New Orleans charity hospitals, but the ability of the state of Louisiana to provide care to its residents who can’t afford health insurance.
Should we read between the lines here? Is it relevant that David Vitter has received $636,000 dollars from health care professionals and $196,000 from the insurance industry? Are the Bush Administration and state Republicans collaborating with private hospitals and insurance companies to privatize Medicaid in Louisiana? Who really benefits from that type of policy? When Jindal breaks his silence, on who’s side can we expect him to fall?
Thank you for one of the most comprehensive distillations of this story and the current realities I have ever read.
yeah, thanks bro.
it is enraging that anyone would suggest leaving control over the state’s underpriveledged in the hands of health insurance conglomerates. of all organizations, the insurers! by allocating state funds to cover the premiums of private insurance for the uninsured, what happens when health care premiums continue to rise in the future? essentially we’d be tying the state budget into a commitment to continue to pad the profits of private insurers, most of which (even blue cross blue shield) are not based in louisiana, over the coming years.
understanding insurance economics is not an easy task, you can get the perspective of the industry here http://www.flains.org/public/ht_irate.html-ssi
which essentially blames the rapid increase of health insurance premiums on the double-digit inflation of health-care costs.
This is a great post … I will be linking to it on Daily Kingfish. By the way, the reason that Baker opposes the new LSU/Hospital being built in New Orleans is because he wants it in Baton Rouge.
I cannot think of any other reason why he would be opposed to it being in New Orleans, other than that. He is one of those “let’s keep everything in my district” type of legislators.
This issue is very complex, with more factors than I am aware of. But from the ones I am aware of, I know that the issue isn’t just about private business repubs vs. states’ rights demos.
I agree that vitter/feds have their interests tied to business. But Blanco and the rest have interests tied to big (federal VA) money under their control, under LSU control. Either way, poor people get screwed. Charity was magical and saved countless lives, no doubt, but it was mainly used by poor people who never seemed to get healthier. I don’t know if spending tons of money to build a hospital will guarantee top-notch care unless non-poor people go there. I don’t know if they could attract non-poor people because the ratio of non-medicaid to medicaid patients has decreased post-katrina and there are several private hospitals in the area that won’t just go away if a huge charity is built.
I don’t think “outcome” improvement for indigents will be worth the money if they build a huge hospital. That’s because ill-health and no-insurance, though correlated, have no direct relationship; they’re just on the same side of the class divide. So if you build a big hospital, lives will be saved, but they could’ve been saved with the current charity building (which, depending on what you read, is either totally great or falling apart). But politicians aren’t interested in saving lives, just getting their friends rich or building state-of-the-art wastes-of-money.
But if you give vouchers to the uninsured, they’d get the diagnoses and prescriptions they need, but they’d be no healthier, and it would be an exponentially increasing budget expense, continuously fueling more state/federal GDP into national HMOs, pharmaceutical companies, and hospital groups. Neither option will change society… the only difference is who’s getting rich, out-of-towners or tiger-fans?
The real issue, to me, is that no one admits that New Orleans was screwed BEFORE the hurricane… so charity lovers glorify the old building even though New Orleans was among the unhealthiest cities nationwide. More focus should be on what we know will help people live healthy:
-primary care– prevent illness (charity was tertiary care, i.e. cure sickness)– community clinics that integrate medicine and lifestyle and diet are much more cost-effective and socially just than a hospital megaplex
-social services– schools, afterschool programming, attract better teachers with better pay, public transport (no fresh fruit in walking distance, but plenty of gas-station chicken!)
-psychiatric issues– crime, substance abuse, katrina, poverty: all linked to psychiatric issues
That’s my 2.1 cents!
great article, Daniel!