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The Road to Wellville

Foundations and industry groups continue to pour support -- and cash -- into an aggressive, private health-care study, but public policymakers have yet to get on board.

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It has been professed that health is the open-sesame to the sucker's wallet. In the late 1940s, for instance, many Louisianans blindly plopped down $3.50 for a bottle of "Coozan" Dudley LeBlanc's infamous Hadacol patent medicine, even though poverty was among the most persistent ailments of the day. The elixir from Abbeville may have been mixed with boat oars behind a small barn, but its 12 percent alcohol content proved to be an irresistible draw -- particularly in the hands of a huckster like LeBlanc.

Today, of course, pharmaceutical research and development is not as superficial as it was in LeBlanc's heyday, thanks in part to the Food and Drug Administration -- although direct marketing techniques appear to be just as bold, if not flamboyant. Another thing that hasn't changed, at least in Louisiana, is some people's willingness to put up big bucks in the name of health concerns. Just consider that public and private groups are expected to pour approximately $2 million over the next year into the Public Affairs Research Council (PAR) to fund a comprehensive health-care study by the group and hire a senior researcher.

The first briefing from the long-term study was issued last month, and PAR tapped a former high-ranking state official to direct the research. Since then, school associations, business lobbyists and industry groups cranked out positive reviews backing PAR's recommendations.

Others, meanwhile, seem hell-bent on ignoring the effort, opting instead to wait on a modern snake oil of sorts to cure the dilemma. For example, state legislators have yet to take an interest in the undertaking, says PAR president Jim Brandt.

"We have had no response from lawmakers, which is unfortunate," Brandt says. "They aren't interested in talking about this. We thought we would have heard something by now."

Gov. Kathleen Blanco and other state officials hosted the Governor's Healthcare Summit two years ago to generate ideas, one of which was the formation of the Governor's Healthcare Forum. As a result, regional hearings have been held all over the state, but tangible results are hard to find.

Meanwhile, PAR already has its first set of recommendations.

The first briefing addressed several issues and highlighted a dysfunctional structure that is ripe for reform. On a national level, Louisiana is a high-spending state, but in its study, PAR could not locate a health care area where the money was being used efficiently. And more often than not, sacrifices were made on the backs of patients.

"Louisiana's health-care system is organized to deliver inefficient institutional care at the expense of primary and preventive care," Brandt says. "Spending priorities in the health budget are focused on institutions and providers, rather than patients."

The study concludes that Louisiana lacks the infrastructure to provide its citizens, especially the uninsured population, with basic health-care services. It goes on to make several recommendations:

• Transfer certain emergency room visits to a doctor's office or clinic, saving around $300 per case. If one-half of all non-emergency ER visits were diverted in this fashion, the state would save $40 million annually.

• Establish an initial investment of $50 million in state or federal grant money to help develop new health centers and clinics around the state, specifically in the hurricane-ravaged areas.

• To assist with the extraordinary expenses related to treating Medicaid patients, the state should bankroll $36 million over three years to phase in a major Medicaid fee increase for primary-care physicians and other physicians in short supply. The bottom-line result could be more people seeing more doctors.

• Restore medical care to rural parishes and other underserved areas by providing incentives for primary-care physicians to practice there. This would require an initial investment of $25 million in state or federal grant money.

• Relax practice requirements for non-physician clinicians or mid-level practitioners to enable them to practice independently in some cases.

• Provide no-interest loans to physicians in metro New Orleans to assist them in re-establishing their medical practices.

The recommendations have caught the eyes and ears of the Louisiana Association of Business and Industry (LABI), one of the state's most influential lobbies. In particular, LABI CEO Dan Juneau notes that the state's archaic Charity Hospital system saw a steep decline in patients in the years leading up to the storms. At the same time, private hospitals saw a large influx of uninsured patients streaming into their emergency rooms for basic care.

"Like a volcano belching ash and shaking the earth with tremors, our illogical system of government-focused healthcare has given strong indications of an impending disaster for a long time," Juneau says. "PAR makes a strong case that the time to act is now -- and the reforms needed are very apparent."

A recommendation to double the enrollment in school-based health centers has also caught the attention of the Louisiana Assembly on School-Based Health Care. The group recently put out a press release urging the state to consider PAR's $10 million recommendation to develop more such centers.

"The PAR Report gets it exactly right in terms of school-based health," says Angie Ruiz, LASBHC president. "School-based health is a cost-effective way to deliver quality health care to youth. They're a captured audience at a school, so they are more likely to actually get the physical or come in for the immunizations they need."

David Hood, the former secretary of the Louisiana Department of Health and Hospitals, prepared the PAR briefing. Hood was hired as PAR's senior health care policy analyst earlier this year, thanks in part to a lead gift of $200,000 from the Franciscan Missionaries of our Lady.

PAR's ongoing capital campaign will fund other health-care briefings in the coming year, including the challenge of providing for the uninsured, long-term care for the elderly and disabled, and state Medicaid spending. Those helping to fund the effort thus far include the Baton Rouge Area Foundation, Community Foundation of Shreveport-Bossier, Ella West Freeman Foundation, Keller Family Foundation and the RosaMary Foundation.

Brandt says there will likely be another eight to 10 briefings issued in the series, with the second one arriving later this month. It is hard to predict much else, he adds, especially when the effort relies on the kindness of others.

Still, it is better than waiting on the results of another government forum.

Jeremy Alford can be reached at jeremy@jeremyalford.com.

Even during the poor economic times of the 1940s, - Louisianans were willing to pay $3.50 a bottle for "Coozan" - Dudley LeBlanc's infamous Hadacol elixir, perhaps partly - because it was 12 percent alcohol.
  • Even during the poor economic times of the 1940s, Louisianans were willing to pay $3.50 a bottle for "Coozan" Dudley LeBlanc's infamous Hadacol elixir, perhaps partly because it was 12 percent alcohol.
Jim Brandt, president of Public Affairs Research Council, - says, "Louisiana's health-care system is organized to deliver - inefficient institutional care at the expense of primary and - preventive care."
  • Jim Brandt, president of Public Affairs Research Council, says, "Louisiana's health-care system is organized to deliver inefficient institutional care at the expense of primary and preventive care."

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