Being Sensible About Uninsured

The State of Louisiana must address the problem of the part of its population that has no health insurance, and it should not rely on the status quo to do so.

Last December, after a year of meetings, the Louisiana Health Care Redesign Collaborative submitted its recommendations to federal and state officials. The plan called for moving away from a Charity Hospital approach for the delivery of indigent health care and more toward a system in which those with no private health insurance—including the indigent—would be covered by insurance.Ü

The ink wasn’t dry on the document before the political skirmishes broke out over the role the Charity Hospital system would play in any redesign effort.

Turmoil is one of the predictable by-products when politics interfaces with money. That is certainly the case in the current health care debate. Michael Leavitt, secretary of the U. S. Department of Health and Human Services in Washington, would like to see the state end its “two-tier” system of health care coverage which tends to channel the poor into the Charity Hospital system and private payers into the private system.

Leavitt champions a system in which some of the dollars now spent to run the Charity system are used instead to purchase health insurance for the indigent. The defenders of the Charity system not only want to preserve the current system, but are attempting to engage in a new round of bricks-and-mortar expansion that could carry a heavy price tag into the future.

The major criticism some state officials have regarding Leavitt’s approach is that it would not cover all of the uninsured in Louisiana. While there may be some validity in that claim, there is also validity in challenging the huge number the state is using as its estimate for the number of the uninsured.

A recent analysis by some of the members of the redesign collaborative would indicate that the state’s number may be overstated by 150,000 individuals. If that is the case, something similar to the Leavitt approach of using an insurance model as the primary delivery system and letting the dollars follow the patients has enhanced feasibility.

A major development in the health care redesign debate occurred Feb. 16 when the Legislature, in a mail ballot, rejected authorizing $300 million for moving forward with a new Charity Hospital in New Orleans.

That vote indicates that there is considerable support in the Legislature for moving away from the old “two-tiered” system and more towards an insurance-based model. The vote—which must have felt like a thunderbolt to the status quo supporters—opens the door for further discussions and perhaps a compromise on this most important issue.

A new system should be piloted first in the greater New Orleans area where there is a critical need for restoring and improving the health care delivery system.

The approach could use an enhancement of the existing LSU-run University Hospital while the demographic trends—and their impact on health care delivery—are better determined. A continuation of the successful public/private partnerships developed in the wake of the storm in the area of graduate medical education should also be a centerpiece of an alternative solution. Both the health care safety net and the private sector delivery system need each other in that area right now.

By working together to best use precious financial and manpower resources, they can both emerge stronger. If the state pushes forward with its status quo approach, all parties concerned may well emerge as losers.