SADOW: Lots Of Posturing On The Charity Hospitals

Previously, this space asked whether, as a result of a legislative initiative to insert Louisiana’s legislature in administrative decision-making, the Gov. Bobby Jindal Administration would play along or humiliate legislators. But the actual rout that has happened and will continue to occur stems not from the Governor’s Mansion, but from the power of ideas.

Last week, the Senate passed a resolution declaring that one of its committees had to approve of any specified contracting activities for public hospitals. Later, the House joined in with a concurrent resolution saying the Joint Legislative Committee on the Budget should do essentially the same, where now the measure moves to the Senate. These were in response to the Administration’s negotiating with nongovernment providers to run the hospitals, effectively becoming the last state to get out of the business of running public hospitals.

Of course, as previously noted, these kinds of declarations are entirely empty given the law and Constitution. Despite that, they got approval as a kind of political fig leaf to hide impotence and to create the impression among constituents that they were vigilantly protecting their interests. The question became whether the Jindal Administration would aid in building this image, which it might have if it could be assured that the faux vetting would not turn into a gripe session or even (admittedly unlikely) symbolic rejection.

The answer came when Jindal pointed out this emperor had no clothes with his statement he would follow the law, not the resolutions. That humiliation, however, means little to the wider world outside of those well-informed about Louisiana government and politics (such as many readers of this space), where, if the subject ever comes up, legislators opposed to the idea of contracting out charity hospital operations will explicate it in a way that makes them look like guardians of the public weal. The larger humiliation they suffer comes from the rejection, if not discrediting, of their agenda and worldview behind it.

For the issue first and foremost for opponents never has been so much of concerns about cost and quality of care as it has been the use of government-owned and run hospitals as a tool to accumulate political power and credit. Those representing areas with these hospitals, their ranks supplemented by a few others ideologically wedded to the idea that government should provide cradle-to-grave maintenance and supervision of people’s lives, have used this provision of service as a means of convincing enough of the electorate that their positions in government were crucial to meeting this need in people’s lives. Additionally, they could make claims that they were instrumental in continuing to provide jobs.

Now with the job supply totally divorced from any connection to their governmental position and with most of the funding authority taken out of their hands, these politicians can claim little in the way of credit for giving people medical care, leaving them one less avenue to convince voters of the need to have them in office. Their fellow travelers who ideologically worship larger government also suffer defeat of their ideas with the rolling privatization of hospital operations that will conclude in a matter of months. These are the genuine, if never admitted, reasons why they have tried to prevent this natural evolution.

Worse for them, predictably the first of these efforts – actually the most extensive of all as it concerns not management but the closure of a hospital, the only one planned because the Earl K. Long facility in Baton Rouge was in such disrepair the clearly cost effective solution was to farm out all activity to the nongovernment sector rather than renovate or rebuild – so far is succeeding as planned. Early indications are the nongovernment sector is responding to market forces. For example, nongovernment hospitals in Baton Rouge are picking up the slack with little difficulty, and the institution winning most of the state government contracted services, Our Lady of the Lake, responded to health needs by opening up a clinic in the area near where the deteriorating hulk of EKL is, and processing more efficiently provision demands, to the benefit of clients and taxpayers.

Over the next month-and-a-half while the Legislature remains in session, perhaps a small amount of rhetoric will emanate from the defeated about legislative oversight, putative Administration high-handedness, and dire, unrealistic predictions about this issue. But observers never will witness the real sting that they will suffer privately and among a few confidants over the next months and even years, as the real world, courtesy of a transformative governor and his legislative allies, invalidates their ideological prejudices and delegitimizes their political positioning.

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