Baton Rouge
(August 14, 2009) -- U.S. Representative Bill Cassidy, MD, will participate
as a reader in Reach Out and Read (ROR) at the LSU Mid City Pediatric Clinic
of the Earl K. Long Medical Center (LJCMC)
on Monday, August 17, at 10:00 a.m.
The clinic is at 1401 N.
Foster Drive in Baton Rouge.
Congressman
Cassidy serves Louisiana’s
Sixth Congressional District.
The event will
highlight the year-round efforts of the LSU Mid City Pediatric Clinic and ROR
to promote crucial literacy skills with parents and their children. The clinic annually distributes at least
6,000 books as prescribed books to children during clinic visits—3,000 are
given by clinic physicians and 3,000 by the dedicated volunteer readers at
the clinic.
“The Reach Out and
Read Program is an important part of our pediatric care because learning to
read is essential for the healthy development of the child,” said Dr. Kathy
Viator, EKLMC hospital administrator.
When it comes to
promoting literacy with parents and children, the messenger matters. The LSU Mid City Pediatric Clinic has a
team of nine physicians and 10 nurses who participate in Reach Out and
Read. They also instruct medical
students on the benefits of the program.
At all pediatric
check-ups for patients from the ages of 6 months to 5 years, medical
providers versed in the benefits of literacy development speak with parents
about the importance of reading aloud to their children and give
developmentally-appropriate books to their patients to take home.
Besides
encouraging literacy in families, another positive feature of ROR is the
early detection of literacy delay. Last year the LSU Mid City Pediatric
Clinic ROR identified 20 children and referred them to appropriate services.
Advising parents
to read aloud to their children reinforces the parent’s role as the first and
most important teacher. ROR also gives
families a critical tool—children’s books.
By the time a ROR child arrives in kindergarten, the child will have
received 10 new, carefully chosen books and will be well on the way to
building a home library.
ROR Louisiana
started in 1995 at the Medical Center of Louisiana at New Orleans and has 58 ROR locations, which
annually serve 50,474 children and annually distribute 99,000 books.
The participation
of Louisiana ROR in the national ROR program is part of a national movement
in pediatric primary care to influence parents to prepare their children to
enter school ready to learn.
With the
endorsement of the American
Academy of Pediatrics
and funding from the federal government, ROR is part of a national network of
4,535 clinics and hospitals in all 50 states, serving 3.8 million children
and their families each year.
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Louisiana State University's
board rejected a governance agreement for New Orleans'
new teaching hospital more than a month ago, and there's still no resolution
between LSU and Tulane
University on this
critical issue.
Gov. Bobby Jindal says the two sides are making progress, but a
settlement is needed now. And the governor should take a hands-on role in
getting that accomplished.
A new hospital is
urgently needed to treat the sick, train new doctors and, in tandem with a
new Veteran's Administration hospital, create a vibrant biomedical corridor
in New Orleans.
This potential economic engine cannot be held hostage in a power struggle
between LSU and Tulane.
The Jindal administration put some initial pressure on LSU
after it shot down the state-brokered memorandum of understanding in June,
and rightly so. Commissioner of Administration Angele Davis suspended land
acquisition efforts for the hospital. Department of Health and Hospitals
Secretary Alan Levine floated the idea of creating a completely independent
governing board.
That suggestion
came after LSU officials argued that they needed control of the board because
the school will own and operate the hospital. The school is concerned that it
would be responsible for the bond debt.
That seems
unlikely since the hospital would be a separate entity, but if the state can
allay those concerns, it should.
Gov. Jindal reiterated the state's goal in a statement this
week: to establish a world-class academic medical center to treat the needy,
train doctors and attract both paying patients and research dollars. And he
said that progress is being made.
But the governor
carries more weight than his surrogates. His personal involvement would
surely be the best way to bring Tulane President Scott Cowen and LSU System
President John Lombardi and their boards back to the table -- and to break
the impasse.
Independent
oversight has been successful at top-tier teaching hospitals affiliated with
universities in other parts of the country, and it would be wise to keep that
model at the forefront of discussions.
The state's
original agreement was reasonable. It gave LSU more control than any other
entity, with four of the 12 seats on the governing board, including the
chairmanship. That compares to one seat each for Tulane and Xavier and a
rotating seat for the other New
Orleans schools. The other five seats, to be filled
by the state, were to be independent of any institution.
LSU's board
instead approved an 11-member board that left the other universities' seats
intact but added another to LSU's tally, reducing the number of independent
seats to three.
Shortly after LSU
rejected the plan, Secretary Levine stressed the need for leadership.
"Leaders lead. It is time for us to get this thing done, and it won't
get solved until the leaders of those two campuses decide to solve it,"
he said.
He's right, but
Gov. Jindal's leadership is what's needed to make
that happen.
http://www.nola.com/news/t-p/editorials/index.ssf?/base/news-6/125040011628200.xml&coll=1
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Gov. Bobby Jindal urged to seize control in LSU-Tulane
dispute over hospital
by Bill Barrow,
The Times-Picayune
John
McCusker / The Times-Picayune
Back of town in New Orleans
where the proposed medical complex may be constructed replacing Charity Hospital and the LSU teaching
hospital.
Some New Orleans
business and political leaders, all of them backers of a planned state
teaching hospital in lower Mid-City, say the time has come for Gov. Bobby Jindal to get more directly involved in settling the
long-running dispute between Tulane University and the Louisiana State
University System over how to run the complex.
The entreaties
come as state Health Secretary Alan Levine reopens negotiations after the
secretary's arduous spring effort ended with the LSU Board of Supervisors
rejecting a proposed governing document for the planned 424-bed, $1.2 billion
hospital.
"This is too
important a project to fail, " City Council
President Arnie Fielkow
said. "It's time to start making decisions. . . . The governor, behind
the scenes, has articulated his support for the new hospital. Given that
there has been no agreement, it may be time for a more personal involvement,
both on (securing) funding and a governance deal."
Kurt Weigle, who leads the Downtown Development District, was
more explicit. He complimented Levine's stewardship, but said: "There's
a really important role for the governor to play in bringing the parties
together and getting this thing over the goal line. . . . At this point, it
would be appropriate for the governor to get directly involved."
Jim McNamara, who
leads the Greater New Orleans Biosciences Economic Development District,
concurred. "At some point, the governor has to get involved, and I think
at this point it could make a difference, " he
said. The district includes the proposed hospital campus.
Jindal, through an aide, declined to be
interviewed about the LSU-Tulane quarrel and the details of a potential
memorandum of understanding for the medical center. Spokesman Kyle Plotkin released a broadly worded statement about Jindal's vision for an "independent" board that
would run a "world-class academic medical center."
The statement
added nothing to what Jindal has already said
publicly, and it offered no clues about what he thinks about the most glaring
unresolved details: whether the new hospital's holding corporation will be
legally affiliated with LSU and, if so, how the seats on the corporation's
governing board will be distributed.
Timeline of talks murky
Plotkin said that Levine remains the
administration's front man on the issue, both in negotiations and in
discussing the matter publicly.
Levine said he
hopes some resolution can be reached as early as next week.
Like the
administration, Tulane and LSU authorities cast the discussions as coming
down to Levine, LSU System President John Lombardi and Tulane University
President Scott Cowen, even as they said the
governor, school board members and several lawyers have talked about the
matter.
But unlike Levine,
Cowen and LSU Board Chairman-elect Blake Chatelain
offered no timeline, and they declined to speculate on whether Jindal could yield progress by increasing his engagement.
Cowen and Chatelain praised Levine's efforts
earlier this year and in a 2008 round of negotiations, the first during Jindal's tenure.
Cowen said he has
not talked with Jindal since the last talks ended
in June. "I would not presume to advise the governor,
" Cowen said. "Our lines of communication with the
administration are open, whomever they send."
LSU System Vice
President Charles Zewe said it does not matter,
because the policy differences would not change with the faces at the
negotiating table.
"It's clear
that Secretary Levine is speaking for the governor, and that is fine, " Zewe said. "This
is not just lying fallow. . . . It's not a simple thing. It's not just a
matter of having John Lombardi, Scott Cowen and Bobby Jindal
in the same room."
Yet the two
schools remain entrenched, with Cowen and Chatelain
agreeing that the next moves will be to react to a new plan the Jindal administration presents.
Chatelain said nothing is on the table.
Board's makeup disputed
In June, Tulane's
board approved the Levine-brokered plan for an LSU-affiliated corporation
with 12 board members: four from LSU, one each from Tulane and Xavier
University, one shared by other New Orleans schools, and five
"non-permanent" members selected by the permanent members but not
tied to any of the campuses.
LSU's Board of
Supervisors rejected that model, with Lombardi
arguing that the plan amounted to the state "using our credit card"
to issue bond debt for construction without giving LSU adequate power on the
board. The school countered with an 11-member board: five LSU members and
only three rotating, unaffiliated members. The other schools' presence would
remain the same.
Cowen said this
week that Tulane will not yield on its insistence that, whatever the model,
the board's largest voting bloc be the independent trustees. "That's the
only way to have a truly independent board, "
he said.
Chatelain said, "I think our vote (in June)
still reflects where our board members are."
But he and Zewe left the door open to reconsider LSU's seat count
under a new model the school believes would not be able to hinder its bond
ratings. "Somebody has to step in and back that debt,
" Zewe said.
Shortly after LSU
rejected the deal, Levine floated the idea of setting up a corporation that
does not depend on the university system's bonding authority.
But the secretary
disputes the claim that the June model actually puts the LSU System on the
hook for the debt. Under that draft, the bonds would be sold under the bonding
authority already granted to the LSU system, but they would be revenue bonds
leveraged against the hospital's future earnings, not the finances of the
university system.
Waiting for the answer
Jindal and Levine have said throughout the
process that the corporation must be set up in a way that keeps the bond debt
from counting against the state's constitutional borrowing limit. Levine
added in a recent interview, however, that political realities dictate that
the Legislature and any sitting governor would always protect the solvency of
the hospital.
"Every state
supports their academic medical centers" regardless of the governance
structure and debt sources, he said.
Levine has yet to
tip his hand on how the state might structure a corporation to answer LSU's
concerns -- or at least take away its argument -- while meeting the
administration's conditions about state debt.
"We're
waiting for Secretary Levine to put something on the table,
" Zewe said. "The timing of that
is of his choosing. We're answering our phones."
In New Orleans, Weigle maintained that it should be Jindal
on the other end of the line.
"I see the
role of the CEO (in any organization) in many cases as the closer, " Weigle said.
"There's a certain point the lieutenants can take negotiations (to), but
then it becomes the time for the boss to come in and wrap up the
details."
http://www.nola.com/health/index.ssf/2009/08/gov_bobby_jindal_urged_to_seiz.html
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Lloyd J. Nelson
III / Houma
Courier
HOUMA — President Barack Obama appears in
medical scrubs with a stethoscope around his neck in a flier mailed to voters
by Republican state Senate candidate Brent Callais.
Norby Chabert, his
competitor in the Aug. 29 runoff for the Senate District 20 seat, takes
offense to the flier, which he contends is an attempt to unfairly link him
with presidential health-care plans.
“He’s trying to
tap the vein of public unrest over the national health-care plan,” Chabert, a Houma Democrat, said in an interview Saturday.
“Time and time again, I’ve said I’m not in favor of the president’s
health-care plan.”
The mailing came a
couple of days after a debate aired on Houma television station HTV where Callais
said he had no plans to use negative campaign materials.
“The whole point
of this is that he looked at everyone on the panel and said he knew of no
negative ads from his campaign,” Chabert said. “And
that’s a lie.”
Callais, of Cut
Off, defends the flier.
“I don’t consider
this an attack ad,” Callais said Saturday. “I’m not accusing him of anything
that he hasn’t publicly stated.”
In public forums, Chabert has said he voted for Obama for president, and
Callais said he voted for McCain. The issue has become a contentious one in a
district where McCain received about 70 percent of the vote in last
November’s presidential election.
Callais said the
reason for the flier is to discredit what he called “false attacks” about Leonard J.
Chabert Medical Center,
the state charity hospital in Houma.
Chabert, son of the late senator for whom the
hospital is named, has claimed Callais wants to close the medical center.
Callais, however, argues that is a distortion of his comments that he would
consider privatizing services at the hospital as long as it does not affect
patient care.
Callais said he is
fully committed to keeping Chabert Medical
Center open wants
voters to know that.
“Despite my
opponent’s false attacks, I would like you to know that I am 100 percent
committed to fully funding all local hospitals, and especially Chabert
Medical Center,”
Callais’ campaign flier reads.
However, language
in the flier that says Chabert “cannot be trusted
on this important issue” of health care has angered the Chabert
camp, especially after Callais’ comments on HTV.
“He says to voters
I can’t be trusted,” Chabert said. “But it looks to
me like he can’t be trusted.”
Chabert said the flier, along with trying to link
him Obama, is simply a distraction from the issues that effect residents in
the district.
“If the campaign
keeps this tone, he’s going to find out what it’s like to be in a fight with Norby Chabert,” Chabert said.
He said too much
has been made about his vote for Obama, which he said he made, in part, because
of votes U.S. Sen. John McCain, R-Ariz., cast
against authorizing the local Morganza-to-the-Gulf
hurricane-protection project and aid for hurricanes Katrina and Rita.
“Those votes that
he cast directly hurt this district,” Chabert said.
“It put water in the houses of my friends and family.”
Early voting for
senate District 20, which covers southern Terrebonne and Lafourche and most
of Houma,
began Saturday for the Aug. 29 runoff. Callais and Chabert
edged out state Rep. Damon Baldone, D-Houma, in the
Aug. 1 general election. The winner serves through 2011, filling the
unexpired term of Reggie Dupre, who stepped down
last month to become Terrebonne’s levee director.
http://www.wwltv.com/topstories/stories/wwl081709mlhoumaobama.eba69813.html
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Associated Press
HOUMA, La. (AP)
- A Republican state Senate candidate in the Houma area casts his Democratic opponent as
a supporter of President Barack Obama's health care plan in a mailer that
shows Obama wearing medical scrubs and a stethoscope.
Democrat Norby Chabert (SHAH' bear) says
the mailer from the campaign of Republican Senate candidate Brent Callais (kal LAY') is unfair: Chabert
has said he voted for Obama but doesn't support the president's health plan.
Callais says he
sent out the flier to counter attacks from Chabert.
Chabert has claimed Callais wants to close the
state-run Leonard J. Chabert medical center in Houma. Callais says that's
a distortion of his comments that he would consider privatizing services at
the hospital as long as it doesn't affect patient care.
http://www.wxvt.com/Global/story.asp?S=10940628&nav=menu1344_2
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Baltakis
named to advisory panel
By William Johnson
Donna Baltakis of Eunice has been named to LSU Health System's
University Medical Center Community Advisory Committee.
That board helps advise the various charity hospitals throughout the state,
including University Medical Center
in Lafayette.
"That is our
charity hospital for this area. They are setting up an advisory board to help
them determine if the people's needs are being met," Baltakis
said.
She attended her
first meeting Aug. 4 but already feels UMC can do better.
"Our local
hospitals, especially our emergency rooms, are feeling the strain because UMC
is not meeting the need," Baltakis said.
"I hope that my appointment will assist the people of St. Landry Parish,
as well as all the parishes within Acadiana, in
accessing better health care.
"I look
forward to working with the hospital administration of UMC and the board to
educate the community about the role, functions and impact of the
hospital."
Baltakis, who has a medical background, was
appointed to the board by the Legislature. She gives state Rep. Mickey
Guillory, D-Eunice, credit for helping her navigate the nomination process.
"The people
of St. Landry Parish had not had a representative on this committee for a
while," Baltakis said. "We will now have
a voice. So often, the needs of the rural parishes are forgotten."
Baltakis already is active in her community,
serving as community liaison for the Local Interagency Networking Coalition.
"LINC brings
community members together for information sharing and coalition building.
Members from the tri-parish area include nonprofits, community organization,
civic and governmental entities, health and social service groups, schools,
law enforcement, chambers of commerce, churches and concerned citizens,"
Baltakis said.
She also has
served as president of the Eunice Service League, secretary of the Myra Burson Foundation for the elderly and disabled, as a
board member of the United Community Health Center and as a legislative
volunteer for then-state representative — now a state senator — Elbert
Guillory.
She is married to
Tony Baltakis, a professor of history at LSU Eunice
and director of the LSUE Performing Arts Series.
http://www.dailyworld.com/apps/pbcs.dll/article?AID=2009908160315
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Louisiana agencies cutting jobs as budgets shrink
by Robert Travis
Scott, Capital bureau, The Times-Picayune
BATON ROUGE -- The
Justice Department resorted to layoffs. The Revenue Department eliminated
jobs and reduced work hours. The Insurance Department offered retirement
incentives. And almost all state colleges are withholding standard pay
increases.
All across Louisiana government,
agencies are cutting personnel costs to adjust to smaller budgets in
difficult times. So far in the fiscal year that began July 1, the effect is
not deep, but it is sweeping in its scope. And it could represent a reversal
of the payroll expansion that for many years has been a consistent trend in Louisiana, with the
exception of the aftermath of Hurricane Katrina.
"With our
persistence in position reductions and hiring freezes, I think you're seeing
that we've passed a turning point where we are strategically reducing the
size of government and will continue to do so," said Commissioner of
Administration Angele Davis.
Strategic
decisions, such as closing New Orleans
Adolescent Hospital
and streamlining Charity
Hospital operations,
certainly have reduced the number of state workers.
But the primary
driver appears to be dramatically lower state tax revenue and oil and gas
income, a situation Gov. Bobby Jindal and the Legislature
chose to accept during the spring session rather than increase taxes. The
governor has warned that the worst might be yet to come, as bailout money
given directly to Louisiana
from the federal government's economic stimulus package runs out in two
years.
That, to use an
expression often heard these days in the Capitol, is when everyone falls off
the cliff.
Still, many remain
hopeful that a resurgence of the national economy will fuel stronger state
revenue and relieve the crisis.
Change of scenery
Jindal entered office in 2008 with a bright
revenue picture and the continuing effort to restaff
New Orleans'
public health care services after Katrina. State government jobs increased
that year. The total state budget for the current year is $28.2 billion, down
almost 5 percent from last year.
As the new reality
sunk in, job growth started tilting the other way. At the beginning of July,
full-time employees in state government numbered 89,091, down by 280 since Jindal took office. Job reductions now under way are
likely to decrease state employment further.
The Office of
Civil Service is handling an extraordinary number of requests from agencies
seeking permission to implement layoffs or layoff-avoidance measures, such as
work-time reductions or ceasing the usual annual practice of giving employees
4 percent pay increases. In fiscal 2008, civil service had 11 such requests;
In fiscal 2009, it had 77 requests -- including 42 in June alone.
In recent weeks
civil service has approved layoffs for more than 50 state institutions. Most
managers will be implementing those this fall, and the total body count has
not yet been tabulated. New rules have given agencies more flexibility in
handling staff adjustments, and seniority is less a factor in deciding who
goes and who stays.
Retirement helps some
Retirement
incentives are now available to agencies seeking to reduce work force. At the
Agriculture Department last month, 43 employees eligible for retirement
agreed to leave in exchange for lump-sum payments roughly close to half a
year's salary. The move will save the department $800,000 this year.
At many agencies,
managers are reducing staff through attrition or by simply eliminating vacant
positions. Here and there, straight-out layoffs have been necessary.
Attorney General
Buddy Caldwell let go 24 people at the Justice Department. Thirteen were laid
off and 11 chose retirement. In addition, one person was reassigned. The cuts
were painful.
"The workload
has not decreased even though the budget has decreased," said Renee
Free, director of the attorney general's administrative services. "We do
not have control over the volume of work we are required to handle. So when
our (positions) are cut we either have to work
longer hours or contract work out to private law firms."
Universities faring well
When the
Legislature debated budget cuts during the spring lawmaking session, the
greatest anguish was expressed by the state's college systems. Although many
education programs have been cut, the layoffs have been less severe than once
feared.
In the Louisiana
State University System, the main campus in Baton Rouge
is laying off about 24 employees to save $2.2
million and the University
of New Orleans is
letting go about 35 people, representing $1.7 million. Other schools in the
system are cutting mostly part-time workers.
The college
systems have been on a roller coaster of good and bad news. Originally
targeted for budget cuts of more than $200 million, higher education received
cuts of about half that amount. Part of that loss was offset by tuition
increases, for an overall reduction close to 5 percent for the current fiscal
year. About 1,700 employees in the LSU System were slated for furloughs, but
a hiring freeze will save enough money to avoid the unpaid leave policy, at
least temporarily.
"While this
may be a reprieve, the idea of furloughs is really not being set aside; it's
just being deferred," said LSU System spokesman Charles Zewe. "We fully expect to see another mid-year
budget cut coming up."
Meanwhile, two new
commissions are working on recommendations for streamlining higher education
and overall state government operations. Their plans come due next year and,
if implemented, could play a role in further reducing the state's work force.
Old hand in agriculture
Agencies
interested at peering into the future might look at the experience of the
Agriculture Department. It has been overhauling operations in reaction to
severe financial stress for two years, partly due to lower fee revenue for
agency services and large debts acquired under former Commissioner Bob Odom.
Commissioner Mike
Strain, who took over in 2008, inherited a $102.3 million budget his first
year but now is coping with an operations budget of about $88 million. He has
consolidated offices, eliminated most part-time positions, removed
hundreds of vehicles from the agency fleet and closed laboratories and
maintenance facilities.
His ranks of
full-time employees have fallen from about 800 to 644, some gone though
direct layoffs.
"A number of
people wear multiple hats, and they will continue to do that. People are
being asked to take on more responsibilities, especially in the executive
areas," Strain said. "We're not hiring from the outside unless we
have no choice."
http://www.nola.com/news/index.ssf/2009/08/op102libbtop2_0817aaa01_79351.html
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Shreveport Times | 08.16.09
By Melody Brumble
Opponents of
health reform proposals pending in Congress worry that a public option health
insurance plan could take away freedom of choice when it comes to doctors.
That's a common
perception when it comes to government-funded health care programs,
particularly Medicaid. However, Shreveport
resident Chris Taylor discovered that Medicaid patients do have a choice — at
least some of the time — when it comes to picking a doctor.
Taylor, 60, started looking for a private eye
doctor who would take Medicaid after a bad experience at LSU Health Sciences
Center-Shreveport's eye clinic. She found Dr. Stephen Lewis, an associate
with Steen-Hall Eye Institute, through a referral service LSUHSC-S offers.
Thus far, that is
Lewis' only private doctor. She visits an LSUHSC-S clinic for routine
physicals every six months and Feist-Weiller Cancer
Center's Partners in
Wellness program for mammograms.
Now she waits
three hours or so for her turn during the clinic appointments and sees a
different resident each time. She said the wait is worth it because she's
been without health care and knows important it is.
"You don't
have the same doctor, and that might bother some people," Taylor acknowledged.
"The stability is provided by the nursing staff and the people who do
your blood pressure. I think my medical records are on the computer,
too."
Choice often is
limited by whether or not a doctor will take Medicaid, which covers children,
the poor and the disabled, and Medicare, which covers people 65 and older.
Neither repays doctors or hospitals the actual cost of their service.
Medicaid repayment is 70 percent to 80 percent of cost, while Medicare
reimbursement runs about 90 percent of cost.
It's more common
for doctors to refuse Medicaid patients, but some are starting to say no to
Medicare.
Evelyn Hassell, 89, of Shreveport
sympathizes with the doctors but also keeps a close eye on her health care
costs, including a rising premium for her supplemental Medicare policy.
"Medicare
doesn't pay doctors what they charge. Sometimes I feel sorry for
doctors," Hassell said. "I had one doctor
who would not accept Medicare. Since he would not do that, you had to pay him
cash every time you went."
http://www.shreveporttimes.com/article/20090816/NEWS01/908160310/Health-care-insurance-choice-a-concern
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Shreveport Times | 08.16.09
By Melody Brumble
Douglas Collier/The Times
Wendy Crow poses with her husband, Joe, and their
three children Jolie, 1, Braven, 3, and Zack, 7, at
their home in Bossier City. Crow recently lost her job and was the sole
source of income and health insurance for the family. She and her husband go
to LSUHSC for care and her children are on the LaCHIP
program.
For Wendy Crow and
her husband, Joe, health care comes down to a single question: Can we afford
to go to the doctor?
The Crows are
among an estimated 16 million Americans who fall in the gap between Medicaid
and private insurance. They make too much money to qualify for the former but
not enough to pay for the latter and still feed, house and clothe themselves
and their three children.
Helping people in
that situation may be the only thing on which lawmakers, health care
professionals and the insurance industry agree as the debate about health
care reform continues.
Bitter public
exchanges, television commercials, Internet and advertising volleys and
everything from unintentional misinformation to outright fabrication obscure
serious discussion about ways to make sure everyone has access to affordable
insurance and health care.
Crow, 33, of Bossier City, maintained health insurance for Joe and
herself during six of her nine years as a cocktail waitress at Eldorado
Casino in Shreveport.
Joe stayed home to care for their children so the couple wouldn't have
childcare expenses.
She dropped the
insurance before the birth of her second child because her share of the
premiums rose to more than $300 a month. Her base pay started at $2.50 an
hour and topped out $3.01 during her time at the casino. Like other servers,
she depended on tips to supplement the base.
She received
prenatal care through Medicaid while pregnant with her third — and final —
child. A state children's health insurance program covers her children's
doctor visits. Wendy and Joe shop around for their care. They depend on LSU Hospital
when faced with an emergency like Joe's broken ankle.
"When I had
the insurance, I was a fanatic for going to the doctor," Wendy Crow
said. "Now I don't go unless I'm really sick. My husband needs some
fillings. We had been planning to do that for about a month. I called around
and got estimates. I found someone that will do it for $80 per filling per
tooth."
Wendy Crow just
started a new job as a bartender at a chain restaurant in Bossier City after losing her job at
Eldorado. She's excited about the low-cost insurance plan the restaurant
offers after a three-month waiting period.
"I'll make
$2.13 an hour. The insurance is $8 per person every paycheck. It won't be
much of a check, but we'll have insurance," she said.
The Crows would
qualify for any of the health insurance subsidies or tax credits outlined in
health care reform proposals pending in Congress. The idea behind subsidies
and other highlights of the broad reform bills is to make sure all Americans
have access to health care.
Supporters and
opponents of the reform efforts disagree about the exact number of uninsured
people who should be counted. The U.S. Census Bureau estimates there are 47
million uninsured people in the nation, including an estimated 7 million
undocumented immigrants. Another 12.3 million — more than half of them
children — are eligible for Medicaid but aren't enrolled for whatever reason.
The rates of
uninsured children in Louisiana
declined from 12.9 percent to 5.4 percent at the end of 2008, in part because
of aggressive sign-up campaigns by the Louisiana Children's Health Insurance
Program.
Program
representatives visit grocery stores, schools and apartment complexes
throughout the year. They hold enrollment at key times throughout the year,
including the weeks leading up to the start of school.
Tameka Williams
visited a recent enrollment event at a Bossier City Housing Authority
community center to get school supplies for her daughter and information
about low-cost health care for acquaintances.
Williams landed a
job as an accounting clerk at the Port
of Shreveport-Bossier after
graduating from Wiley
College. She said she
has good insurance that covers her and family members. Health insurance and
other benefits were among the factors she weighed when looking for a job.
"I love the
Port and the Port loves me," Williams said, laughing.
However, she
realizes others aren't so fortunate. She collected LaCHIP
and Medicaid flyers and applications to pass on to others.
"I know a few
people who have gotten laid off from their jobs and lost benefits, or they
don't have benefits," Williams said.
The percentage of
uninsured adults in Louisiana
was nearly 22 percent at the end of 2008, slightly higher than in 2003,
according to state Health Department statistics. Regional rates vary. The
rate in northwest Louisiana
was 25.8 percent at the end of 2008, compared to 21.6 percent in 2003.
Shreveport native Paul Mladenka,
24, found himself without insurance after he got too old for coverage under
his parents' employer-sponsored health insurance plan. He plans to seek
insurance through a small business — a barbecue restaurant — he opened in
Port Allen a month ago. The restaurant employs about 25 people, including Mladenka and his brother, Michael Mladenka,
25. The brothers got their food service start at Superior Grill in Shreveport as teenagers.
The restaurant
will offer health coverage to the owners and some managers, but not all
employees, Paul Mladenka said. He noted that he
might look at whether the company could afford to offer coverage to more
workers.
Mladenka is concerned about the "pay or
play" parts of the reform proposals. Employers would have to provide
health insurance, the "play" part, or pay fees for uninsured
workers. The fees range from a percentage of the company's yearly payroll to
a fee for each uninsured employee. The proposals also outline the employers'
portion of health insurance premiums, ranging from 50 percent to 72.5
percent.
"Hopefully,
with the help of our insurance agents and our legislators, it won't happen,
but it if it does, we'll cross that bridge when we come to it, no matter how
wobbly that bridge is," Paul Mladenka said.
Stephen Wright,
CEO of Christus Schumpert
Health System, admits he's conflicted by the state of health care in the United States.
He understands the bottom line and the bind health care providers face with
rising costs and stagnant reimbursement.
However, he still
believes there should be some effort toward universal access to primary care
doctors, preventive care and routine health testing, as well as a focus on
education and personal responsibility.
"The truth of
the matter is, ultimately everybody has to give a little something up, and
everybody has to ..."
Wright also
believes that everyone shouldn't be guaranteed the same amenities, like a
private room and an extensive choice of hospital meals, although everyone
should have care and treatment of the same quality.
"If you can
contribute to the cost, you might get different amenities," Wright said.
"For example, one person who works here might drive a Cadillac and one
might drive a Ford. They're different cars, but they both get you where you
need to go."
The proposals
pending in Congress also include requirements to encourage or force
individuals to sign up for insurance. The requirements would be backed with
tax penalties that could be waived if a person meets income limits.
Etta King, of Shreveport, might face
penalties if the reform comes to pass. King, who celebrated her 65th birthday
in August, turned down Medicare, saying it's too expensive.
"They want
$96 and something out of my Social Security for Medicare," she said.
"Then I'd have to get a supplemental policy, and that would probably be
$200 a month. You're going to owe something even if you have Medicare, even
if you have the supplemental Part B policy."
She draws Social
Security and works full-time to pay her rent, car note and other bills. Her
employer offers health insurance, but she said she can't afford the premiums
for that because of her age.
"I go to LSU Medical
Center. I've been going
there for five years," King said.
Her daughter and
son-in-law have employer-sponsored insurance but still tally up co-pays for doctors visits, surgery and related costs. She recalled
that a recent surgery required a $500 co-pay just to
the hospital.
"The bills
for the anesthesiologist and things like that aren't here yet," King
said. "Health care has just gone through the roof."
http://www.shreveporttimes.com/article/20090816/NEWS01/908160304/-Can-we-afford-to-go-to-the-doctor?-
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By JJORDAN BLUM
Advocate Capitol
News Bureau
The swine flu
appears to have hit Sorority Row at LSU, with about 20 students contracting
influenza during the beginning of Greek rush week, the university reported
Saturday.
The symptoms are
“mild to moderate” thus far and the affected students were sent home.
No sorority
recruitment week events have been canceled, said Herb Vincent, LSU associate
vice chancellor for communications.
“Multiple
sororities have been affected — it’s not just one,” Vincent said, noting that
most of those who are ill are incoming freshman students.
There is no cause
for alarm at this time and LSU officials are continuing to monitor the
situation, Vincent said.
Affected students
were advised to remain at home for at least seven days after the first signs
of the illness or until 24 hours had passed with no symptoms of the illness,
per recommendations from the U.S. Centers for Disease Control and Prevention.
Vincent said he
did not know how the students contracted influenza.
The students were
diagnosed with Type A influenza. Routine tests for
the swine flu, also known as the H1N1 virus, are no longer being conducted by
state and federal agencies. However, it is presumed that any Type A influenza circulating at this time of the year is the
H1N1 virus, Vincent said.
LSU also has
e-mailed students on campus for sorority recruitment to take precautions to
avoid and reduce the spread of illness, such as covering the mouth and nose
while coughing or sneezing, cleaning hands with soap and water, and cleaning
frequently used surfaces such as books, counters, desks, doorknobs and
keyboards.
For the
convenience of students, the LSU
Student Health
Center announced special
weekend hours of 2 p.m. to 5 p.m. Saturday and today, with normal hours resuminn Monday, Vincent
said.
Sorority
recruitment week began Saturday and runs through next Saturday.
LSU reported its
first case of swine flu earlier last week. But the ill student lives off
campus and was not seen as a threat to start a campus outbreak.
In a separate
incident, a 21-year-old woman from the New Orleans
area who died Wednesday became Louisiana’s
first known death from the H1N1 virus, according to the state’s health
department.
The Centers for
Disease Control and Prevention say more than 6,500 people have been admitted
to hospitals because of illnesses from the virus, and 436 have died.
The Department of
Health and Hospitals says more than 350 cases of H1N1 have been confirmed in
the state since the virus emerged in spring.
http://www.2theadvocate.com/news/53343552.html
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The first Louisianian to die of complications of H1N1 flu, or swine
flu, is a reminder that this year's influenza season will represent a
higher-than-normal threat.
The 21-year-old
woman living in metro New Orleans was the
first death among Louisiana's
346 confirmed cases of H1N1 flu. Health officials, however, believe the
actual number of cases in the state may exceed 15,000, since most people do
not seek medical attention for influenza. Nationally, the disease is
responsible for about 6,500 hospitalizations and 436 deaths, according to the
Centers for Disease Control and Prevention.
The good news is
that most people afflicted with swine flu are expected to recover without
needing medical care. There's treatment for those seriously ill, and the vast
majority of patients have responded well to it. In addition, researchers are
already testing a new vaccine for the H1N1 strain.
Just as important,
however, will be for everyone to be on alert and to take basic precautions
that can greatly reduce the spread of the disease. Those include washing
hands frequently, covering coughs and sneezes, staying home when you feel bad
and avoiding people who are sick.
Officials also
urge getting a shot for the conventional flu. It won't include the swine flu
vaccine, but it's something people can do until an H1N1 shot is approved.
More information is available at the CDC's Web site, www.cdc.gov.
Authorities do not
know which population groups face higher risk from this virus, but they
believe it may be the same groups with higher risk of contracting seasonal
influenza. That means the elderly, children,
pregnant women and people with compromised immune systems need to be extra
careful.
But all of us can
help reduce the impact of swine flu once this mean season begins.
http://www.nola.com/news/t-p/editorials/index.ssf?/base/news-6/1250486460227910.xml&coll=1
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Louisiana cuts physicians' Medicaid payments
By Chris Silva, AMNews staff
Louisiana will be paying less to physician practices
and hospitals for treating most Medicaid patients as a result of emergency
reductions taken by the state government early in August.
As part of a
declaration of emergency issued Aug. 4, the Louisiana Dept. of Health and
Hospitals announced reduced payments to physicians of about $19 million, and
to hospitals of about $40.5 million, over the next fiscal year.
Doctors who care
for Medicaid patients younger than 16 will not see payment reductions for
those services. But physicians who provide certain services to older patients
will take about a 10% reduction for that care, DHH said.
Louisiana implemented these cost-containment
measures as part of an effort to reduce total spending by about $240 million.
Earlier this year, the state revealed it would have $1.2 billion less in
Medicaid revenues for fiscal 2010, which began July 1.
"Louisiana is facing an
extraordinary problem that is unparalleled in history -- the largest
reduction in our federal match to Medicaid that any state has ever
faced," said Alan Levine, the DHH secretary.
Because the state
received a large amount of federal funding to help with reconstruction
efforts after Hurricane Katrina, the state's per capita income jumped by 42%
from 2005 to 2007. As a result, it is now facing a "cataclysmic
drop" in federal Medicaid funds, Levine explained, that is going to cost
the state about $700 million over the next year. In addition, $368 million in
federal stimulus assistance is set to expire in December 2010.
"There is no
way for our state to cut at the margins to handle that type of federal
reduction," Levine said.
Physicians fearful
Physicians and the
state medical society have been closely monitoring the situation. They are
concerned about how the cuts will affect doctors with low-income and disabled
patients.
"It would discourage
us from taking any patient with Medicaid," said William LaCorte, MD, an internist who treats about 400 nursing
home patients in the greater New
Orleans area.
Louisiana has one of the largest Medicaid patient
populations in the U.S.
Dr. LaCorte said the cuts could start affecting staffing, as
the loss in money for his practice would be just about equal to the salary of
a nurse practitioner. "I think it disproportionately affects poorer
areas and nursing home residents."
The DHH's Levine explained that the state is doing the best
it can in attempting to fix budget shortfalls that have been partly the
result of damaging natural disasters.
"Some
physicians are going to face a reduction," he said. "This is not
ideal. We're not happy about this, and this is not what we want to do, but
we're facing some harsh realities here. Being disciplined and planning is the
best thing we can do right now."
The state also is
looking to rein in Medicaid payments for what Levine describes as avoidable
hospitalizations, and it is starting a new disease management initiative Jan. 1, 2010,
for patients with asthma, heart disease and diabetes. He is hopeful that this
will help reduce unnecessary trips to the state's emergency departments and
control health system costs.
Lower payments to
hospitals and physicians accounted for two-thirds of the total DHH reductions
detailed in the emergency announcement.
Rural areas impacted
The federal
government has been paying for 72% of Louisiana's
Medicaid program. But by 2011, that share will shrink to 63%, because the
federal government is counting hurricane relief funds as income.
The decrease is
likely to cause physicians to stop taking new Medicaid patients or halt
Medicaid services to adult patients entirely, according to the Louisiana
State Medical Society.
"This could
occur in a very insidious way," said Vincent A. Culotta
Jr., MD, chair of the society's council on legislation. "When one doctor
stops, others in the community will become overburdened, and they will stop
because they'll realize they're not making money and can't provide the
service."
Dr. Culotta said his society has worked hard with the DHH and
the federal government on reducing health system costs while at the same time
ensuring that patients have access to the care they need. But he said the
upcoming cuts will go much too deep.
"We have one
of the largest Medicaid patient populations in the country right now,"
he said. "This will ripple through the rural hospitals and providers, as
well as the metropolitan areas. Many of our physicians will work hard to
provide care, but when it costs $12 to provide care and then they get
reimbursed $10, they just can't do it forever."
While New Orleans and other
metropolitan parts of the state also will be impacted, Dr. Culotta predicts that patients in rural areas will feel
the greatest impact. "It's going to be harder in those areas, because
there may not be a nearby local emergency room, and the patient may have to
travel longer distances and therefore not go until it's much more critical
and the expense to care is greater."
http://www.ama-assn.org/amednews/2009/08/17/gvsb0817.htm
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The New York Times | 08.16.09
By SHERYL GAY STOLBERG
PHOENIX — The
White House, facing increasing skepticism over President Obama’s call for a
public insurance plan to compete with the private sector, signaled Sunday
that it was willing to compromise and would consider a proposal for a
nonprofit health cooperative being developed in the Senate.
The “public
option,” a new government insurance program akin to Medicare, has been a
central component of Mr. Obama’s agenda for overhauling the health care
system, but it has also emerged as a flashpoint for anger and opposition.
Kathleen Sebelius, the health and human services
secretary, said the public option was “not the essential element” for reform
and raised the idea of the co-op during an interview on CNN.
Mr. Obama himself
sought to play down the significance of the public option at a
town-hall-style meeting on Saturday in Grand
Junction, Colo.,
when a university student challenged him on how private insurers could
compete with the government.
After strongly
defending the public plan, the president suggested that he, too, viewed it as
only a small piece of a broader initiative intended to control costs, expand
coverage, protect consumers and make the delivery of health care more
efficient.
“The public
option, whether we have it or we don’t have it, is not the entirety of health
care reform,” the president said. “This is just one sliver of it, one aspect
of it.”
For Mr. Obama,
giving up on the public plan would have risks and rewards. The reward is that
he could punch a hole in Republican arguments that he wants a “government
takeover” of health care and possibly win some Republican votes. The risk is
that he could alienate liberal Democrats, whose support he will also need to
pass a bill.
On Sunday, Senator
John D. Rockefeller IV, Democrat of West Virginia, affirmed his support for
the public option. “I believe the inclusion of a strong public plan option in
health reform legislation is a must,” Mr. Rockefeller said in a statement.
“It is the only proven way to guarantee that all consumers have affordable,
meaningful and accountable options available in the health insurance marketplace.”
White House
officials say the president has not abandoned the idea of a pure government
plan, a central feature of the legislation moving through the House. But Ms. Sebelius’s comments did seem to open the door, and at
least one Democrat close to the White House said the administration was well
aware that, with moderate Senate Democrats opposed to the idea of a public
plan, Mr. Obama might have to give up on the notion to get a bill through.
“The president is
going to continue to try to persuade everyone of the great value of having a
true public plan,” said this Democrat, who spoke on condition of anonymity to
avoid discussing strategy publicly. ”But at the end of the day, I believe he
recognizes that there are other, arguably less effective, ways to achieve
greater coverage, more choice, better quality and lower cost in our system.”
In an interview on
Sunday, Mr. Obama’s senior adviser, David Axelrod, said the president
remained convinced that a public plan was “the best way to go.” But Mr.
Axelrod said the nuances of how to develop a nonprofit competitor to private
industry had never been “carved in stone.”
On Capitol Hill,
the Senate Finance Committee is expected to produce a bill that features a
nonprofit co-op. The author of the idea, Senator Kent Conrad, Democrat of
North Dakota and chairman of the Budget Committee, predicted Sunday that Mr.
Obama would have no choice but to drop the public option.
“The fact of the
matter is, there are not the votes in the United States Senate for the public
option,” Mr. Conrad said on “Fox News Sunday.” “There never have been. So to
continue to chase that rabbit, I think, is just a wasted effort.”
The co-op, modeled
after rural electric and agricultural cooperatives in Mr. Conrad’s home
state, would offer insurance through a nonprofit, nongovernmental consumer
entity run by its members. Mr. Axelrod said one downside of a co-op, from Mr.
Obama’s point of view, was that it might be unable to “scale up in such a way
that would create a robust” competitor to private insurers.
And whether a
co-operative would actually bring Republicans on board with Mr. Obama is
unclear. Senator Richard C. Shelby, the Alabama Republican who appeared
alongside Mr. Conrad on “Fox News Sunday,” called the co-op idea “a step in
the right direction,” adding: “I don’t know if it will do everything people
want, but we ought to look at it. I think it’s a far cry from the original
proposals.”
As Mr. Obama
envisions it, the public option would be a government-backed plan available
to consumers through a health exchange where people could buy insurance,
public or private, that best fits their needs. While a public plan might
require some government financing to start up, the idea is for it to be
financially self-sustaining and require no subsidies, Mr. Axelrod said.
Republicans argue
that a public plan would invariably drive private insurers out of business
and prompt employers to drop private coverage, pushing people who are already
insured onto a plan run by the government. Mr. Obama counters that a public
option would keep insurers “honest” by forcing them to compete in the
marketplace, although he has said all along he would be open to other ideas.
In her interview
Sunday on CNN, Ms. Sebelius was asked if it was
time to come up with an alternative to the public option. She replied that
the president’s main concern was to promote competition with the private
sector.
“What’s important
is choice and competition,” she said. “And I’m convinced at the end of the
day, the plan will have both of those.”
Here in Phoenix, where Mr. Obama
is to address the Veterans of Foreign Wars on Monday, conservative groups
including Americans for Prosperity are planning to protest the health plan.
The same groups have turned up around the country at Congressional
town-hall-style meetings, which have sometimes turned into shouting matches
as opponents denounce him for promoting “socialized medicine.”
Mr. Obama is
pushing back. As the nation heads into the last two weeks of August, a time
when the White House believes many Americans will tune out of the health care
debate to take their vacations, he has been waging an intense public
relations offensive to convince Americans that the health care system should
be overhauled. (He, too, is planning a vacation, to Martha’s
Vineyard the last week of August.)
In the past week
alone, Mr. Obama has held three town-hall-style meetings — in addition to the
session on Saturday in Grand Junction, he traveled to Portsmouth, N.H., and
Belgrade, Mont. — and devoted his weekly radio and Internet address to health
care. On Sunday, he published an opinion article in The New York Times
arguing, as he has in recent days, that overhauling the system would result
in protections for consumers.
“This is not about
putting the government in charge of your health insurance,” Mr. Obama wrote.
“I don’t believe anyone should be in charge of your health care decisions but
you and your doctor — not government bureaucrats, not insurance companies.”
http://www.nytimes.com/2009/08/17/health/policy/17talkshows.html?_r=1&ref=health
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By NICHOLAS WADE
The standard
treatment for infection with the hepatitis C virus is a grueling 48-week
course of the antiviral drugs interferon and ribavirin
that gives some patients flulike symptoms and severe depression. The
treatment varies in its effectiveness, being much more successful in
Americans of European descent than in African-Americans.
A Duke University
team has now uncovered the principal reason for the disparity between the
races. It lies not in differing compliance to the treatment or access to
health care, as some have assumed, but in genetics.
Using a genetic
test called a genome-wide association study, the Duke team, led by David B.
Goldstein and John McHutchison, found that the
coding at a single site on the DNA, out of the three billion sites in the
human genome, made all the difference in people’s response to the treatment.
The site is close
to the gene for a special kind of interferon, known as interferon-lambda-3,
and may help control the gene’s activity. Some people have the DNA unit T at
this site, and others have C. Since a person inherits two copies of the
genome, one from each parent, individuals may have T’s on both copies, C’s on
both, or one T and one C.
People with the CC
version, or allele, respond much better to the standard hepatitis treatment
than do those with the TT allele. The C versions are more common in Europeans
than in Africans, and this explains half of the difference in the response
between the two races, the Duke team said in a report released Sunday on the
Web site of the journal Nature.
The C versions are
even more common among East Asians, about 75 percent of whom respond well to
the standard treatment, compared with 55 percent of European-Americans and 25
percent of African-Americans.
People with the CC
versions may produce more interferons, which are virus-fighting
substances produced by cells, than those with TT, though the exact mechanism
has yet to be worked out.
Dr. Goldstein, a
population geneticist, said the different frequencies of the T and C versions
were the result of natural selection, which is particularly effective in the
case of disease resistance.
“We have clearly
had very strong selection in the human population for resistance to different
infectious agents, which have been of different importance in different parts
of the world,” he said.
Presumably in the
past some virus struck with particular severity in East Asia but was less
potent in Europe and even milder in Africa.
Dr. Goldstein said this virus might not have been the hepatitis C virus,
which is spread by blood-to-blood contact, as when needles are shared, a
practice common only in modern times. But he said he did not know what other
virus might have been responsible.
He and Dr. McHutchison, a clinician, said a genetic test based on
the finding would be of great interest to patients and physicians as a
component of the decision on whether to undergo the standard treatment.
The study was
financed by Schering-Plough, which owns the intellectual property rights on
any diagnostic test developed from the discovery. Robert Consalvo,
a spokesman for the company, said that the finding was an important first
step but that he did not know of immediate plans to develop a diagnostic
test. “Schering-Plough is not a diagnostic company,” Mr. Consalvo
said.
Dr. McHutchison said a test would not be used to deny anyone
treatment, but rather to determine a patient’s best options.
People who have a
lower chance of benefiting from the grueling treatment because they have the
TT allele might decide to wait until better drugs become available, especially
if their liver damage is not severe. On the other hand, African-Americans
with the CC allele might be more confident in accepting the treatment, Dr. McHutchison said.
In the United States,
hepatitis C infects about three million people and causes 10,000 deaths a
year, according to the Centers for Disease Control and Prevention.
http://www.nytimes.com/2009/08/17/health/research/17hepatitis.html?ref=health
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The New York Times | 08.15.09
By RICHARD THALER
WE clearly don’t
need any more distractions from the two main issues of health care reform:
how to deal with our large uninsured population and how to make the entire system
more cost effective. So, for now, let’s ignore the shouted rhetoric about
whether “death panels” want to kill off Grandma or whether President Obama
wants to turn the country into a socialist state.
But even if we
discard these absurdities, and tune out the raucous scenes at town-hall
meetings, one big distraction remains: the question of whether a “public
option” should be part of the health care solution. To me, the issue is a red
herring, and is getting in the way of genuine reform.
In debating the
public option — that is, an insurance option run by the government — the
politicians themselves are making exaggerated claims about its pros and cons.
We hear from the right that an insurance plan run by the government will
drive all private-sector insurers out of business and be the first step
toward socialism, if not communism. The left claims that only a public option
can give evil insurers the competition they need to create much-needed
reform.
To evaluate these
contentions, we need to know some details about how a public option would
work in practice. And those details have been missing.
For example,
President Obama has said that the public plan would be required to break even
financially, but Congress hasn’t decided how to make that happen. (Of course,
the poor may have to have their health insurance subsidized, but those
subsidies could go to both public and privately operated insurance
companies.) Nailing down this detail is crucial. If the public option does
not have to break even — if, in fact, it is to receive government subsidies —
then it is correct to worry that it would destroy competition, not foster it.
If the public plan runs a deficit, who will fix it? If it is Congress, we
have to worry that what should be economic decisions will turn into political
battles.
A second detail is
whether the government will grant the public plan the power to impose special
deals with suppliers like hospitals and drug companies — a move that would
dampen, not enhance, competition with the private sector.
But let’s assume
that the public option does have to break even and can’t make any special
deals. What should we expect to happen?
Here is a thought
experiment: Can you think of a domain where a government-run business
competes successfully with private-sector companies? In a town hall meeting
last week, President Obama mentioned one such example: the market for
overnight shipments. This market now has two main private suppliers, FedEx
and UPS, and one public one, the United States Postal Service. When you have
to send something overnight, which one do you use? Most shippers choose one
of the private companies. (Indeed, even the idea that we need a
government-run postal service is doubtful. Sweden has successfully
privatized its postal service. Sweden! And the European Union
will open mail service to competition in 2011.)
The Postal Service
offers another instructive lesson. When it periodically starts running
deficits (as it is now) and proposes cost-saving measures like eliminating
Saturday delivery or closing tiny post offices, Congress often intervenes
under pressure from predictable interest groups like bulk mailers, the
600,000 postal employees, and the users of those tiny offices.
More generally, it
is hard to find examples where government-run businesses compete with private
companies and win. One reason is that governments are not very good at
innovation. As the great 19th-century economist Alfred Marshall wrote, “A
government could print a good edition of Shakespeare’s works, but it could
not get them written.”
But what about the
often-stated fact that Medicare has much lower operating costs than private
insurance companies? Won’t this allow the public option to compete
successfully? As Victor Fuchs, the dean of American health economists,
recently argued in The New England Journal of Medicine, this is not an apt
comparison because the new public plan would have marketing and other
administrative costs that don’t apply to Medicare with its captive market.
ALL of this leads
me to conclude that if we impose sensible rules on the public option, it will
neither save nor destroy the health care system because it will simply not
get much market share. And if we do not impose those rules, the public option
will hurt rather than help.
So here’s some
free advice to members of Congress: While you are enjoying your August recess
and town hall meetings, instead of arguing about whether to have a public
option, argue about the ground rules.
To the
Republicans, I say this: If you can get real assurances that the public
option has to break even, and that it will get no special deals from
suppliers, let the Democrats have it but ask for concessions on tort reform
in return. (That could actually save some money.) The resulting public plan
will be too small to notice.
To the Democrats,
I say this: If you want competition in health care, you won’t get it if the
public option can make deals its competitors can’t. So either give the
Republicans hard assurances that the public option would have to break even
and not get special treatment, or, better yet, just give it up to ensure that
some useful health care reform is passed. A public option is neither
necessary nor sufficient for achieving the real goals of reform, and those
goals are too important to risk losing the war.
Richard H. Thaler is a professor of economics and behavioral science
at the Booth School of Business at the University of Chicago.
http://www.nytimes.com/2009/08/16/business/economy/16view.html?ref=health
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