How big should Big Charity be?
The good news is that the feds have approved $74 million of the funding for land acquisition and start-up costs. The bad news is that HUD has a long list of questions it wants answered before it will release the other $226 million that would be applied toward the $1.2 billion total price tag for the project.
It appears obvious that the federal agency has some serious concerns about the project, and those concerns don’t focus just on the need for a teaching hospital in New Orleans to replace the old facility. Instead, they appear to center on whether Louisiana’s archaic system of providing indigent healthcare will continue, or if it will be reformed into a more efficient system.
Michael Leavitt, Secretary of the U.S. Department of Health and Hospitals, made the Bush administration’s concerns about continuing the old “two-tiered” system of healthcare very clear during his work with a state-appointed healthcare redesign collaborative that ended its work late last year. It is obvious that the federal agencies would like to see the new Charity Hospital be an integral part of a redesigned system that would encourage more public/private healthcare partnerships and allow indigent patients more choices about where they can access healthcare. On the other hand, it is just as obvious that much of the leadership in our state government is dead set against doing any reforms that would challenge the Charity Hospital delivery system.
During the year-long meetings of the healthcare collaborative that worked in conjunction with Leavitt’s agency, a strong case was made for refocusing the role of the Charity Hospital system and allowing more dollars to follow the patients in both the public and private sectors. However, when the meetings were over, our state officials balked at pursuing an approach that would result in significant changes.
What is at stake is much more than whether or not the federal government will approve $300 million to go toward a new public hospital in downtown New Orleans. The basic issue is: Will Louisiana utilize the $300 million and potential Medicaid waivers to redesign a system that currently leaves much to be desired? Indigent and uninsured patients, tired of the lack of access to primary and acute healthcare, are flooding into private healthcare facilities to get uncompensated treatment from facilities and providers. This strain on the system is reaching the breaking point. Unfortunately, many state officials are more concerned about keeping the status quo and maintaining the number of state employees on the payrolls than they are with fixing a major problem.
Some in state government have made it clear that, if the feds don’t approve the full amount of the $300 million for the new hospital in New Orleans, they will just proceed with their plans and bill Louisiana taxpayers for the cost. Don’t expect those individuals to support any changes in a system that fails to adequately cover many of the indigent and uninsured who need care and are placing a huge financial hardship on private providers.
Change comes slowly in Louisiana, and our public healthcare system is a prime example of that fact.
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