SADOW: A Good Hospital Deal, And The Special Interests Hate It

The agreement among Louisiana, St. Tammany Parish and a private Florida-based firm to run some of the space (not already operated by another entity since 2010) at Southeast Louisiana Hospital wins for all – unless you are a true believer in the faith that government must run health care facilities and lots of other things, as are some stick-in-the-muds who complain about the deal.

Under extraordinary budget pressures stemming from a sudden federal government decision to reduce Medicaid payments significantly to the state, the Gov. Bobby Jindal Administration decided to close abruptly the psychiatric facility. As both the region and state are well above average in beds available, no real crisis existed, but if the market would bear more, an operator would come in.

And one did, at least for a smaller number of beds, enabling the state to save about $200 per patient, reducing the economic effects of the retrenchment, and providing more care options. Better taxpayer value, gainful employment, services rendered – one would think this would make everybody happy.

Think again. At least for some leaders of the Committee to Save Southeast Louisiana Hospital having the object of its name achieved in fact dismayed them. One even suggested it might be illegal, entirely misinterpreting a statute that applies to the sale, not contracting, of nonprofit, not government-owned, hospitals.

Getting some capacity back under a private operator displeases these individuals because it does not involve government operation. Implicit in their argument is that the nongovernment sector cannot provide as good care, where they evince an attitude that the free enterprise system in this area (as much as it can be with the significant constraint that so much of this sector is paid for and controlled by government regulation) acts deleteriously on the delivering of mental health care, implying perhaps government should take over all medical provision.

Naturally, this opinion is built on pure buncombe. Most health care delivery in the country is done by the nongovernment sector, and even the majority of it in Louisiana, and it excels in a comparative sense. To deny that market forces do not provide better incentives for improved provision of health care displays lamentable ignorance about human beings and their behavior.

But it goes beyond just faith in big government that drives this animus. Big government means more jobs with more benefits relative to those with similar duties and responsibilities outside of government. This acquiescence of wanting to do less with more in part and parcel of the ingrained learned dependency on government shaped by Louisiana’s populist political culture that has held this state back in economic, cultural, and political development for most of the past century.

You see it with this event, with the wailing about attempts of the state to remove itself from warehousing the disabled and running nursing homes, with the resistance to provide alternatives to the government monopoly model of education, with opposition to fixing a fragmented and generous employment pay and benefits regime for state employees, and with a general desire to maintain an inefficiently-organized higher education structure. What they all have in common is a regrettable tendency to put private interests ahead of those of those being served and of those paying for that provision.

It’s a constant series of battles ahead for reformers wishing to change the culture, who even among themselves sometimes run afoul of letting an atavistic populism obstruct this process – such as with this incident, where at first some conservative reformers sounded more like populist liberals in their reaction to this. Which is why a victory in this instance is so valuable, despite the efforts of special interests to obscure this fact.

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