LOUISIANA HEALTH CARE IN THE SPOTLIGHT

An opportunity for real reform

Even before the hurricane hit, Louisiana had the second-highest uninsured rate, one of the least innovative Medicaid programs, one of the region's highest per-capita Medicaid and Medicare costs, some of the worst patient outcomes, and was the only state in the nation to own and operate a network of charity hospitals. Although these New Orleans-area hospitals were an important part of the medical community — a training ground for the state's health-care professionals and a source of specialized trauma care — they more and more often were diverting patients due to a lack of facilities and staff, and were in many areas barely clinging on to accreditation.

We are now faced with an enormous challenge to rebuild a city. In the wake of this challenge it is crucial to rebuild a health-care infrastructure by providing financial and regulatory relief to our health-care providers, and ensuring that Louisianans have access to personalized health-care services. We can, and should, be innovative in our thinking, turning New Orleans new health-care system into the model for the rest of the country.

According to press reports, a volunteer physician from Pennsylvania rushed to the New Orleans area to help the lone doctor performing triage at a makeshift center put together at the airport. While administering chest compressions to a dying woman days after Hurricane Katrina struck Louisiana, this physician was ordered to stop treating patients since he was not registered with the bureaucracy sitting in Baton Rouge and thus could cause legal-liability issues. The misguided concern over potential lawsuits prevented this physician from using his skills to save lives.


This is another example of how bureaucracy and red-tape fails to meet the critical needs of the American people. Everyday, in less dramatic fashion, bureaucracy impedes the delivery of high-quality health care. The American Hospital Association estimates that nurses in many settings spend an hour filling out paperwork for every hour they deliver care, while the head of the Mayo Clinic once estimated there were 130,000 pages of rules and regulations in the Medicare program alone. It is critical to ask: Who do we want to be in charge of making health-care decisions? Do we want the same bureaucracy that botched initial relief efforts? Or empowered patients working with their physicians to personalize health-care needs?

We must have consumer-driven health care which allows each patient to make the best choices for their individual needs. A one-size-fits-all approach is not the best way to meet the individual needs of families impacted by the storm. Enabling individuals and families to have this kind of personal ownership over their plans will ensure that those dislocated by Katrina have immediate health care. It will also provide portable benefits so individuals impacted by the hurricane can bring their health-care coverage back with them to Louisiana or other affected regions.


Before Hurricane Katrina, too many of our people in Louisiana received their non-emergency care in emergency rooms due to a lack of access to other affordable services. As we rebuild, we should concentrate on increasing access to out-patient and primary care. This should include making private insurance more affordable. Refundable tax credits, new insurance products including health-reimbursement arrangements and health-savings accounts, state-run purchasing pools, and regulatory relief must be provided to make it easier for individuals to purchase private coverage. In the short term, refundable tax credits can be offered to make COBRA and private insurance coverage more affordable.


One of the quickest and most affordable ways of increasing access to high-quality affordable care is to provide families with jobs that provide employer-sponsored health-care benefits. Workforce training, aggressive tax relief, perhaps including suspension of capital gains and income taxes, regulatory relief, and other incentives must be provided to encourage the creation of jobs for individuals impacted by Hurricane Katrina.

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Tough Medicaid choices ahead for Congress: "After a quiet August in Washington as members of Congress returned to their states and districts, the Capitol roared back to life in September because of budgetary deadlines. Congress continues to explore how it will come up with budget savings. Prominent on the chopping block is Medicaid, the largest of all federal health programs. The Hill and leagues of lobbyists are galvanized as Congress works to put a slight dent in future Medicaid growth. Medicaid began 40 years ago to serve as a safety net for the very poor. The first year's cost was $1.3 billion in combined state and federal government expenditures. In 2005, the program will cost $329 billion ..."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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