Plan gives hope
Buzz up! Gov. Bobby Jindal's recently announced framework plan for health care reform in Louisiana is an encouraging high note following more than a decade of study and rhetoric on the issue.
The Louisiana Health First plan most certainly doesn't have all the answers right out of the gate, but it appears to have a real chance to revamp the way the state provides health coverage to the poor and uninsured. If it can curb rising costs and improve care, a sustainable system will evolve, with patients and taxpayers reaping the benefits.
With Louisiana at or near the bottom in so many critical health indicators, there's little disagreement that there's plenty of room for improvement. Jindal's overall health care reform agenda begins with what Newt Gingrich called "a brutally candid assessment of where Louisiana currently ranks relative to other states — 48th in obesity, 49th in infant mortality, 48th in cancer fatalities, 47th in adults with health insurance coverage and 50th in overall health outcomes."
By taking on a maze of federal red tape and seeking solutions outside of established policies, Jindal and his health care advisers are showing out-of-the-box leadership via a complicated series of negotiations and tradeoffs involving Louisiana's $7 billion Medicaid program and some $771 million in contested health care overpayments.
If those issues can be resolved and federal approval is forthcoming, the Health First initiative would restructure services to Louisiana's Medicaid recipients, who make up a quarter of the state's more than 4 million residents. Under the new plan, participants would be able to choose the services of a "coordinated care network" that would manage and track their care. The network would be a group of public or private health care providers such as hospitals, community clinics, centers and doctors' offices, which would contract with the state. Instead of the current flat fees for care, individual prices would be negotiated among networks and providers.
Under the redesigned system, supporters say, patients could avoid redundant testing, get preventative treatment earlier and stop turning to expensive emergency rooms for care that could be obtained elsewhere at lower cost. Skeptics want to know more about how the networks would be coordinated and their performance measured as well as how the dollars would flow.
There is much left to do before a viable program is in place. What's clear is that Louisiana has many of the worst health outcomes in the nation, an inefficient and cumbersome financing mechanism, and an unstainable health care system for the poor and uninsured. What is encouraging is that real reform is possible. In the days and weeks prior to the next legislative system, may studious and concerned dialogue produce a care system that is healthy — both literally and figuratively.
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