Almost 10 months ago, I was asked to serve on what became the Louisiana Health Care Redesign Collaborative. The group was formed to develop recommendations on how to redesign the devastated New Orleans health care system.

U.S. Secretary of the Department of Health and Human Services Michael Leavitt has met with us on several occasions. At each meeting, he mentioned the same three criteria that he is looking for in the plan: the current "two tier" system must be replaced; the dollars must follow the patient; and there needs to be public/private partnerships in the new model. To most individuals, that would not appear to be a "radical" agenda. Each of those criteria has a lot of merit and has been recommended as a potential reform long before Michael Leavitt ever showed up in Washington.

What seems to be at the center of the current controversy is the role the Charity Hospital system will play in the redesign model—if there is indeed going to be a new model. Governor Blanco has now gone on record saying there will be a new teaching hospital for LSU built in New Orleans, and she wants it built with federal funds. One of the major decisions that should have been made long ago in the collaborative's deliberations is what role would the charity system have in a redesigned system. This question has been brought up numerous times by collaborative members, but a resolution was always put off. The question is important, because hundreds of millions of dollars in federal "disproportionate share" dollars are used almost exclusively to fund the Charity Hospital system. Those dollars are a significant source of funds that could be used to help finance a new model.

Nothing precludes the Charity Hospital system from being a part of a new model. If that system wants to compete for the dollars following the patient, it is well positioned to do so.

However, if the governor's announcement of a new public hospital for New Orleans also means that all of the disproportionate share money currently in the Charity system must remain there, the funding model for a new system just isn't likely to work.

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