he good news is that the laid-off nurses and doctors in the charity hospital system will be quite likely to find new jobs pretty quickly. Those professions are in great demand.
The bad news is there is good reason to believe that patients, unlike the doctors, won’t get the solicitude of the state, as state-run hospitals are going to be essentially dismantled in a rush.
Whatever one thinks about the wisdom of the state-run hospital system, we think people should be dismayed about the way Gov. Bobby Jindal does business.
The governor has shown precious little regard for the little guy who is accustomed to the charity hospitals. He has exploited a Medicaid budget crisis to give the false impression that the state has no choice but to eviscerate the charity hospitals. And he hides behind a set of Jindal-appointed members of the LSU Board of Supervisors to do the hatchet work. A profile in courage it’s not.
All that said, is the general policy correct? Suppose we had a governor who would do the tough and thoughtful spade work to bring all the interested parties to the table and work out a reformed system. Then, we’d say that we’d want to go in that direction.
Unfortunately, as the Public Affairs Research Council recently noted, things are being done in a rush. “The frantic approach currently under way does not bode well for a successful transition for citizens or our communities,” PAR said.
We have long argued that the far-flung system of a state-run hospital in every area of the state would be difficult to maintain and needed to change. If anything, the approach of Obamacare has made it more likely that more poor people could get private insurance that would be accepted in private hospitals. Other changes would also further crimp the finances of the charities now run by the LSU System.
And there is good reason to believe — for a long time, disputed by LSU’s medical educators — that large public hospitals are not absolutely essential for the education of doctors and nurses; we’ve seen more evidence lately that farming out students and residents to private hospitals is not only feasible but makes the old charity hospital model less reasonable under today’s new financial situation.
Today’s Medicaid financial crisis is making all this almost, pardon the word, academic. The governor has directed the cuts shall fall on public hospitals, and that’s what is happening.
With the domination of the LSU board by Jindal appointees completed, the board is rushing into drastic cuts without, in many cases, the completion of private-sector contracts to take care of the patients displaced. In this time of disruption, we hope that LSU medical schools will be able to continue to attract quality medical students and residents.
The model for the transition is the partnership with LSU and Our Lady of the Lake. It is a complex set of agreements that have been years in the making, after it became clear that the state didn’t have the money to replace the aging Earl K. Long Medical Center in north Baton Rouge. And the LSU/OLOL deal is not yet operating, although we are confident it should work out well for patients and the state.
Similar agreements aren’t even begun for other areas, even as layoffs in the hospitals occur. The easiest part, we hope, is that private hospitals can provide the in-patient beds to meet the medical needs of the uninsured, with a minimum of the health-care bureaucracy with which patients rich and poor are familiar.
As PAR noted, the idea of rushing this transition is going to result in hardships for communities, patients and the medical professionals who have done so much good work for the uninsured.
Is all this the state’s fault? Not at all. Federal aid to the state comes with many restrictions, and this transition could have been eased in many ways by federal regulators. Still, the operational problems remain in a rush to privatization of the service providers.
We can only hope that members of the Legislature and leaders in local communities hold the governor and his appointees responsible for outcomes. For at least a time, in terms of patient health, this is a gamble, not a plan.