St. Charles Herald-Guide

Last chance to do it right?

By Dan Juneau - April 26, 2006

If a system were the only one of its kind in the United States, was very antiquated, and yielded poor results, one would think those in charge of the operation would be desperately trying to reform it. Not so with Louisiana's Charity Hospital system. The genesis of the Charity system was during Huey Long's tenure as governor. In subsequent years, it grew to become the main delivery system for indigent health care across Louisiana. At its inception 70 years ago, it was a progressive approach. But in today's world of federally controlled Medicaid, it's a dinosaur being kept alive by politicians for political purposes.

A report recently completed by Price Waterhouse Coopers for the Louisiana Recovery Authority confirms what independent observers have noted for decades: The Charity Hospital system needs to be reformed and replaced by more private sector involvement in the delivery of indigent health care services. The report notes, that in other states, the burden of caring for the poor is shared between public and private facilities, with the federal reimbursement dollars for uncompensated care available to both groups as an incentive to provide the services. In Louisiana, almost all of the federal uncompensated care dollars go to the Charity Hospital system. When private providers and facilities treat the poor or the uninsured and get no payment, the state prevents them from receiving any federal dollars as a partial reimbursement.

The crux of the report is its recommendation that private and community hospitals both be given some of the "disproportionate share" dollars (money given by the federal government to states with a high percentage of indigent population). Such a move, according to the report, would allow Louisiana to join "the rest of the country in a common vision that one health care system for all offers the best avenue for a higher quality system that is sustainable for all Louisianans."

The Price Waterhouse Coopers report doesn't contain any startling revelations. Much of what it says has been said many times before. What is different is the environment now surrounding the indigent health care issue. Louisiana may have a smaller indigent population in the aftermath of the two hurricanes. If that proves correct, it is even more impetus to reform the archaic Charity Hospital system. Many have also questioned the wisdom of having LSU run the Charity Hospital system. There is a growing consensus that LSU should concentrate on medical education and not have the burden of running a statewide health care delivery system. Price Waterhouse agrees with that notion.

If an antiquated, inefficient indigent health care system can't be changed in the wake of the Katrina/Rita disasters, it may never be changed. But the path to reform will not be an easy one. The bureaucratic grab for dollars and funding will not easily subside. The use of the Charity Hospital network as a political patronage system is a time-honored practice in Louisiana politics. It will take a humongous effort to take the politics out of the system.

In the final analysis, whether or not Louisiana's "unique" and quality-challenged indigent health care system is reformed will come down squarely in the lap of Governor Blanco and the Legislature. Will the governor's hand-picked Louisiana Recovery Authority urge her to support the crux of the Price Waterhouse Coopers recommendations? If so, will she strongly embrace them and use her political capital to make them a reality? And, given all of that, does she have enough political capital to push through the reforms, if she is so inclined? How those questions are answered will write the next chapter of indigent health care reform in Louisiana.