Louisiana Gov. Jindal, LSU, Open N. Baton
Rouge Health Clinic
Written by: BayouBuzz Staff
Today, Governor Bobby Jindal
marked the opening of the new LSU Health System North Baton Rouge Clinic.
Governor Jindal said the new 44,000 square foot
state-of-the-art health clinic will provide comprehensive primary care,
including cancer services and women’s health services. The Governor
emphasized that the new clinic is an example of improving the health care
delivery system in Louisiana.
Governor Jindal said, “With this
new center, we’re taking a critical step towards expanding quality health
care for our people. The LSU Health
System North Baton Rouge Clinic is an example of where health care delivery
should be heading in our state – community based primary and specialty care.”
The Governor said the new facility was built with $13.8
million of capital investment from the state. He said the clinic will be an
umbrella facility for specialty clinics currently housed at Earl K. Long
Medical center. Specifically, the facility has 30 exam rooms, a community
meeting room, a diagnostics laboratory, a pharmacy and radiology services.
he new clinic will
include a Women’s clinic and Primary Care clinic that will provide
comprehensive obstetrics and gynecological services, while a Disease
Management Program within the Primary Care Clinic will offer patient
education to better manage chronic diseases among patients and prevent
Additionally, the Governor noted that urgent care services
will be provided for health care issues that need immediate attention, but
don’t rise to the level of needing emergency care.
Governor Jindal said, “This is a
smart use of resources which will also improve service quality to patients.”
Alan Levine, Secretary of the Louisiana Department of
Health and Hospitals, said, “We applaud LSU for expanding access to primary
care and preventive services for cancer, women’s health and cardiology
through this new clinic. Studies indicate two out of every five cancer deaths
of women ages 50 to 74 could be avoided if they got the recommended
screenings, and this new clinic will be a terrific vehicle for helping us
achieve this goal. And even though
we’re getting better at controlling heart disease in Louisiana, we still have one of the
highest death rates in the country for heart disease and stroke. This clinic
is a big step toward contributing to the improved health of our state.”
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By LANNY KELLER
Advocate Opinion page staff
One thing learned fast in Baton Rouge is tyou
don’t have to dig very hard to get John V. Lombardi
to say what he thinks.
Now, they’re learning the same thing in New Orleans. The blunt Yankee president of
the LSU System is a key player in LSU’s plans to create an academic medical
center — not, LSU officials say, another Charity
Hospital — in the Crescent City.
In a speech to LSU boosters in New Orleans, Lombardi said LSU’s plan for
the management of a new facility will work, and just about everyone else
involved in the discussion should pipe down.
He said state Treasurer John N. Kennedy “didn’t tell the
truth” when questioning LSU’s business plan.
A bill by House Speaker Jim Tucker, R-Terrytown,
seeks to provide what the speaker calls a more balanced management board for
the proposed new center.
Lombardi said he ignored the bill because he didn’t think
anyone would take it seriously.
Then it unanimously passed in the House.
“It turns out there are not so many sensible people as I
thought,” Lombardi said.
The Tucker plan, which Tulane favors over LSU’s proposed
“memorandum of understanding” for the new center’s management, is a way to
“go broke” with a hospital, according to Lombardi.
“Somebody’s got to be in charge,” and LSU’s plan includes
everything Tulane asked for last year in negotiations about the memorandum.
“I don’t know if they can be made comfortable,” Lombardi
huffed about Tulane.
Both sides say they want independent management and a
representative board of institutions, including Tulane and other New Orleans
universities, contributing to the health center. But Tulane believes LSU’s
memorandum stacks the management deck for LSU.
A hospital that is run by the “inefficient, incompetent”
patterns of the past will not be financially or academically viable, Lombardi
said. He said the process is delayed by “historical things we’re hung up on
and I don’t understand.”
As for the Legislature?
“They need to get
out of the way,” Lombardi said. “We’re not asking them for a damn thing.
We’re asking them to get the hell out of our way so we can get this thing
LSU, Tulane, Tucker, Gov. Bobby Jindal
— all are said to be in talks about resolving the management issues with the
hospital’s governance. The tone of Lombardi’s remarks — the recording of the
speech is available on the Internet at http://www.lsuhsc.edu — suggests
Lombardi doesn’t figure anybody else knows how to do this right.
Academic medical centers are “all very much alike if they
are successful,” he said, and there isn’t a separate “New Orleans way” of doing the same thing.
In the same speech, he both claimed ignorance of the
history of Tulane-LSU battles in the past, yet dripped with condescension
about ideas to “preserve old New
Orleans in amber.”
He compared LSU’s plans to the resurrection of Baltimore because of the success of the Johns Hopkins University
medical school and hospital. If “old” New
Orleans wants to stand in the way of LSU’s plan, the
city would be left with “a fight over remnants of a catastrophe.”
At the same time, Lombardi — a historian — said he’s
ignorant of the cultural clash between New Orleans
and Baton Rouge,
or LSU and Tulane. “People speak to me in code I don’t understand,” he said,
referring to what he suggested were dead controversies that aren’t relevant
to the LSU plan for a new type of institution to replace the old Big Charity.
The LSU business plan for the center “shows how this deal
will work,” and the LSU memorandum answers all legitimate objections to the
governance of the new institution, Lombardi said.
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New Orleans CityBusiness |
by The Associated Press
BATON ROUGE - The House agreed 94-2 Wednesday to a measure
that would slow the expropriation and purchase of land for a new LSU hospital
in New Orleans.
House Bill 780 by Rep. Rickey Nowlin,
R-Natchitoches, would stall the land acquisition until lawmakers on the Joint
Legislative Committee on the Budget review and approve financial plans for
Nowlin said he didn't want to
jeopardize the plans for the new medical teaching hospital run by LSU, to
replace the one flooded by Hurricane Katrina four years ago. But he said
lawmakers should have more clarity from LSU about the plans before land is
expropriated, including the costs to the state and the impact on local
landowners and historic property slated to be expropriated.
The budget committee has twice approved plans submitted by
LSU and the current and former governors' administrations on the hospitals.
What must be contained in the proposal required under Nowlin's
bill that would be different from those plans isn't defined.
The proposed hospital has run into complaints from
historic preservationists and some New Orleans
residents who say it would be cheaper and cause less damage to historic
buildings to rebuild the now-shuttered Charity Hospital.
Nowlin's bill heads to the
Senate for debate.
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by Bill Barrow, The Times-Picayune
This area along Canal Street is slated for the site of
a new LSU teaching hospital to replace Charity Hospital.
The Legislature blocked acquisition of the land Wednesday night.
BATON ROUGE -- With little debate, the House voted 94-2
Wednesday for a proposal to block the acquisition of land for the proposed New Orleans teaching
hospital until a key legislative budget panel approves a new financing plan.
Critics of the hospital plans cast House Bill 780 by Rep.
Rick Nowlin, R-Natchitoches, as a common-sense way
to protect private property. State officials and Louisiana State
University executives who run the state's public hospital system,
warn that it could delay an already lagging project.
Responding to questions from New Orleans lawmakers, Nowlin
said he supports a new hospital and has no interest in disputes over its site
and design. He said he wants to avoid major revisions in the plans or the
Legislature having to pony up more cash to keep the project afloat after land
purchases and expropriations.
The proposed state complex, a 424-bed facility pegged at
$1.2 billion, would be bound by South
Claiborne Avenue, Tulane Avenue, Galvez Street and Canal Street. The U.S. Department of
Veterans Affairs plans adjacent facility across Galvez up to South Rocheblave
Street. The state is responsible for all land
acquisition, though Nowlin's bill would apply only
to the state footprint.
House Speaker Pro Tem Karen Carter Peterson, D-New
Orleans, and Rep. Michael Jackson, I-Baton Rouge, cast the lone no votes.
Speaker Jim Tucker, R-Algiers, did not vote. Tucker is sponsor of a pending
bill that could overhaul how the hospital is governed, with the central
question being power distribution between LSU and Tulane.
The Legislature's Joint Budget Committee has already
approved a $1.2 billion construction budget that calls for $300 million in
state support; $492 million would come from federal payments for hurricane
damage at Charity
Hospital; and the rest
from bonds. Only the state money is a sure thing, with no resolution on how
much the federal government will pay for Charity, and that variable, among
others, affecting any bond sale.
Gov. Bobby Jindal, still a
public supporter of the new hospital, said Monday that LSU should update its
business plan, which also would affect any bond sale.
LSU officials have lashed out at the criticism in recent
LSU System President John Lombardi said last week that
the, "Legislature needs to get out of our way." He cast questioners
of the hospital project as a threat to a "last opportunity (for New Orleans) to be a
competitive, high-powered American city." Dr. Fred Cerise, LSU's vice
president for health affairs, got into a heated hallway argument with state
Treasurer John Kennedy after the treasurer questioned LSU's current plans.
The bill now moves to the Senate, likely the Health and
Welfare Committee. Chairwoman Willie Mount, D-Lake Charles, is married to Ben
Mount, a member of the LSU System governing board.
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Jewel A. Carney
Last week I sat patiently through the City Planning
Commission's forum on the VA/LSU hospital project. Even today, after years of
planning, there is still discussion about alternatives. I am a small-business
owner in the footprint of the VA site. My livelihood is on hold. At age 74, I
don't have time to put my life on hold while political agendas are being
discussed at the community's expense. Make a decision and move on so we can
move on with our lives.
Jewel A. Carney
Safe Driving School
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Re: "LSU willing to share hospital power," Page
1, May 13.
Tulane has been involved in Charity Hospital
for 175 years and has never been accused of a conflict of interest. It is
shocking that this accusation would be made by LSU, given the long working
relationship between the two universities.
Tulane has not asked for any significant control in the
new hospital. Its only request is to maintain its historical role to treat
indigent patients and to preserve its residency and training programs, which
benefit the citizens of New Orleans
and the entire state.
House Bill 830 would also make sure the hospital is led by
a group of individuals who have a demonstrated track record of successfully
managing a hospital. As a businessman I know how important it is to hire the
most experienced and talented professionals to lead your organization.
Tulane is supporting Rep. Jim Tucker's House Bill 830,
which embraces independent oversight, public accountability, inclusion and
appropriate fiduciary and other safeguards that will ensure that the public
hospital can achieve its potential, and that public funds are properly used.
Why is LSU or any other institution unwilling to embrace
these principles, which are in the interest of the public good?
The answer to that question is likely to suggest where the
real conflicts lie.
Emeritus Member and Past Chair
Board of Administrators
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Reduces Diabetes Testing Cost by 50%
SALEM, N.H., June 4 /PRNewswire/ -- The makers of the WaveSense(TM) line of blood glucose monitoring products (AgaMatrix, Inc.) announced today their continued
commitment to providing low cost, high accuracy, and high quality blood
glucose monitoring (BGM) products for people with diabetes. The WaveSense Presto(TM) BGM can be found at leading
retailers nationwide, including Wal-Mart(R) and Kroger(R). Presto test strips
(50 ct) are often as low as $22.88, less than half the typical price of
strips from major brands.
The high cost of testing supplies can cause financial
hardship for people with diabetes who do not have complete health insurance
coverage or who do not have insurance. Often times
products that sell at lower prices are not high accuracy or high quality, do
not have a proven track record of meter and strip placement in the market,
and are not readily available to consumers. WaveSense
products feature a new technology that makes testing accurate and affordable
and they are used by hundreds of thousands of patients worldwide.
"WaveSense provides the LSU Health Care Services Division
outpatient pharmacies the means to provide a high quality, affordable blood
glucose monitoring system to our patient population," said Danny
Jackson, System Director of Pharmacy for the LSU Health Care Services
Division. "The no coding feature and the benefits of WaveSense
accuracy deliver a premium, easy-to-use system to the market at a price point
that makes testing possible for those patients with limited or no health insurance."
Affordable BGM testing has become increasingly important
given today's economic environment. Furthermore, the number of people with
diabetes is growing each year, causing both public and private health
insurance to spend even more money treating the disease. Marian Batts-Turner, a leading certified diabetes educator (CDE)
and member of the American Association of Diabetes Educators (AADE) Board of
Directors said, "There is indisputable evidence that better glycemic control decreases the risk of complications in
people with diabetes, such as cardiovascular disease and kidney failure. WaveSense technology uniquely enables affordable systems
for patients to monitor their blood sugar accurately and reliably."
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By Jan Moller
BATON ROUGE -- A Senate committee restored hundreds of
millions of dollars for health care, higher education and other programs to
the state budget Wednesday, setting up a likely showdown with the House and
Gov. Bobby Jindal's administration over the $28
billion spending bill.
The unanimous decision by the Senate Finance Committee
follows three weeks of testimony from state agencies and public hand-wringing
over the effects of budget cuts offered by Jindal
and endorsed last month by the House.
"The Senate is making a strong statement about what
our priorities are and what we are willing to do to enact those
priorities," said Sen. Lydia Jackson, D-Shreveport, the Finance
Committee's vice chairwoman.
Most of the restorations to the budget bill -- House Bill
1 by Rep. Jim Fannin, D-Jonesboro -- are contingent
on the passage of two separate measures: Senate Bill 335, which would raise
$118 million next year by delaying a planned tax cut; and Senate Concurrent
Resolution 81, which would generate $86 million for next year's budget by
tapping the state's Budget Stabilization Fund, commonly known as the
The tax bill faces strong opposition from Jindal and a majority of House members, while the
governor has also urged caution in using money from the rainy-day fund.
Other money to finance the restorations was found by
shifting dollars around in the Medicaid program to maximize the use of
federal economic stimulus dollars, and by raiding a dormant incentive program
designed to attract insurance companies to the state.
The proposed withdrawal from the rainy-day account would
generate $258 million, but only one-third of that money would be used next
year, while the rest would be socked away in a fund and used over the
following two years to offset expected budget shortfalls.
The full Senate is expected to take up the budget bill
Friday. If it passes, as expected, differences between the House and Senate
versions would be worked out in a compromise committee.
Finance Committee Chairman Mike Michot,
R-Lafayette, said many senators have been around the Capitol longer than
their House counterparts, and have seen the effects of budget cuts in ways
that their colleagues across the hall have yet to experience.
"Many of them are new to this process," Michot said.
With state government facing a $1.3 billion revenue drop,
the budget bill came to the Senate with language calling for elimination of
3,600 state jobs, and reductions for just about every state agency and
function. The biggest cuts were slated for health-care and higher education
programs, which take up the largest share of the state budget and are not
protected from being sliced.
Senators added about 1,400 amendments to the budget bill,
making wholesale changes to the version adopted last month by the House.
Among other things, the amendments restored 75 percent of the rate cuts
planned for private providers of Medicaid services, including nursing homes
The amendments would add $108 million for colleges and
universities using money the state would collect by postponing the tax cut.
That money, combined with a tuition increase and other restorations, would
reduce the cut to higher education to less than $100 million, down from $219
million that Jindal initially sought.
Health-care cuts, totaling about $375 million when the
budget came to the Senate, would be reduced to around $170 million with the
committee's amendments. Other restorations include $9.1 million for the New Orleans Adolescent Hospital,
which the governor has proposed to close in a cost-saving measure.
Senators also added about $15 million for members' pet
projects, sprinkled among parish councils on aging, non-profit groups,
festivals, museums and similar programs.
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By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
TRAVIS SPRADLING/THE ADVOCATE
Sherry Phillips-Hymel, center,
chief budget analyst for the state Senate, explains amendments to House Bill
1 on Wednesday to Senate Finance Committee members Jack Donahue, left,
R-Mandeville, and Eric LaFleur, D-Ville Platte. Lobbyists and other interested parties from
institutions got copies after the meeting as well. The measure, which
outlines the state’s spending plans for the fiscal year starting July 1, is
expected to be considered by the full Senate on Friday.
A Senate committee on Wednesday reduced proposed budget
cuts to health care and higher education.
To generate dollars, the Senate Finance Committee
recommended dipping into the state’s “rainy day” fund and delaying an income
Lawmakers also found money for senior citizen programs,
downtown development, public libraries, museums and food banks.
“We felt like it was the general sense of this committee,
obviously, to try to do something to help higher education and health care,”
said state Sen. Mike Michot, R-Lafayette and the
House Bill 1 — the $28 billion proposed operating budget
for the upcoming fiscal year — now moves to the full Senate.
The state is facing a drop in revenue of more than $1.3
billion in the fiscal year that starts July 1. The decline is largely due to
slumping tax collections.
Gov. Bobby Jindal initially
proposed a budget with deep cuts for health care and higher education.
Lawmakers scrambled to find ways to soften the cuts,
especially for the state’s public colleges and universities.
The House suggested tapping into a proposed tax amnesty
program and an insurance fund.
Earlier Wednesday, the Senate advanced its solution to
higher education’s budget problems.
Senate Bill 335 would freeze the amount of federal excess
itemized deductions that state income tax filers can deduct at current levels
through 2011. Instead of being able to claim 100 percent, tax filers would
only be able to claim 65 percent.
The change would result in $118 million in savings for
state government, money that the Senate wants to use for higher education.
The bill appears to face a daunting fight in the House,
where a number of lawmakers are denouncing it.
The finance committee based some of its budget changes on
the assumption that SB335 will clear the House and the governor’s desk.
In addition to finding extra dollars, the committee had to
trim an additional $30 million from the budget because of declining tax
The Senate’s chief budget analyst, Sherry Phillips-Hymel, said the state corrections department weathered an
additional cut of $7 million.
She said the agency will absorb the reduction by being
The committee recommended using $86 million from the
“rainy day” fund next year, a move the governor opposes.
The “rainy day” fund is made of surplus and other money
sources. It was created as a safety net when budget deficits occur.
Jindal has urged lawmakers to
avoid tapping into the fund because the state’s financial problems are
expected to continue for several years. Though the governor said he would
support using “rainy day” funds provided proceeds from tax amnesty replace
the money withdrawn.
With the committee’s changes, higher education stands to
lose about $100 million in funding, less than the $219 million cut proposed
by the governor. Cuts to health care would be whittled to $170 million.
Michot conceded that some will
have to get by on less, such as food banks which are proposed to get only a
fraction of the money they normally receive.
The amendments include:
* $118 million
for higher education.
* $95 million
for private health-care providers.
* $31 million
for legal judgments against the state.
* $5.3 million
for arts programs and tourism marketing.
* $500,000 for
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by The Times-Picayune
BATON ROUGE -- Under pressure from Gov. Bobby Jindal's administration, the House voted overwhelmingly
this morning to reject legislation that would have created a new layer of
oversight for the Medicaid program.
House Bill 717 by Rep. Hunter Greene, R-Baton Rouge, would
have required the state Department of Health and Hospitals to consult with an
advisory group of doctors to review any proposed rules governing rates and
policies in the health-care program for the poor.
While supporters said it would add a new layer of
expertise to the rule-making process, the bill drew strong opposition from
the health department, which viewed it as unnecessary interference in its
ability to set rates.
"We're worried about another layer of bureaucracy.
We're slow enough as it is," Rep. Kay Kellogg Katz, R-Monroe, said.
The bill died on a 29-62 vote.
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by Jan Moller, The
House approves bill to restrict mobile dentist
clinics at public schools.
BATON ROUGE -- The third time proved a charm this morning
for a controversial bill to regulate school-based mobile dental clinics, as
the House voted 64-30 on a compromise that sends the issue to the state Board
House Bill 687 moves to the Senate after weeks of
impassioned debate and lobbying pitting supporters of the Louisiana Dental
Association, which sponsored the bill, against opponents who said it would
deny poor children access to care.
In its original form, the bill by Rep. Kevin Pearson,
R-Slidell, would have outlawed most mobile dental clinics. Critics said the
clinics, which sprung up last year after the Legislature raised the
reimbursement rates for treating poor children on Medicaid, were unsanitary
and discouraged parental involvement in their childrens'
But supporters of keeping the clinics said there had been
no complaints, and that they provide oral care for children who otherwise
would not see a dentist.
The House appeared to be on the verge of killing the bill
last week when Speaker Jim Tucker, R-Algiers, abruptly pulled it from
consideration so changes could be made. Under the reworked version, the Board
of Dentistry would have until the end of the year to develop detailed
regulations spelling out how the clinics can operate.
If the board fails to develop new rules, its members would
"If we've learned anything over this exercise, we've
learned that rulemaking should be kept at the dental board level," said
Tucker, who co-sponsored the legislation.
But critics said the amendments were too specific in its
directives to the dental board, and that the dental board had not been
consulted as they were developed. Others complained about language that
requires dentists to carry a $1 million insurance policy if they want to
provide in-school care.
The amendment was approved on a 65-31 vote.
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WASHINGTON - Medical
bills are involved in more than 60 percent of U.S.
personal bankruptcies, an increase of 50 percent in just six years, U.S.
researchers reported on Thursday.
More than 75 percent of these bankrupt families had health
insurance but still were overwhelmed by their medical debts, the team at Harvard Law
and Ohio University reported in the American
Journal of Medicine.
"Using a conservative definition, 62.1 percent of all
bankruptcies in 2007 were medical; 92 percent of these medical debtors had
medical debts over $5,000, or 10 percent of pretax family income," the
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"Most medical debtors were well-educated, owned homes
and had middle-class occupations."
The researchers, whose work was paid for by the Robert
Wood Johnson Foundation, said the share of bankruptcies that could be blamed
on medical problems rose by 50 percent from 2001 to 2007.
"Unless you're Warren Buffett, your family is just
one serious illness away from bankruptcy," Harvard's Dr. David Himmelstein, an advocate for a single-payer health
insurance program for the United States, said in a statement.
"For middle-class Americans, health insurance offers
little protection," he added.
States is embarking on an overhaul of its
healthcare system, which is now a patchwork of public programs such as
Medicare and employer-sponsored health insurance that leaves 15 percent of
the population — 46 million people — with no coverage.
About 170 million people get health insurance through an
employer but President Barack Obama says soaring health care costs are
hurting the economy and forcing businesses to drop medical insurance for
"Nationally, a quarter of firms cancel coverage
immediately when an employee suffers a disabling illness; another quarter do
so within a year," the report reads.
Obama told Congress on Wednesday he was open to making
mandatory health insurance part of the overhaul but only with exemptions for
the poor and for small businesses.
Neither Congress nor Obama are considering the kind of
single-payer plan advocated by Himmelstein and his
colleague Dr. Steffie Woolhandler.
"We need to rethink health reform," Woolhandler said. "Covering the uninsured isn't
"Only single-payer national health insurance can make
universal, comprehensive coverage affordable by saving the hundreds of
billions we now waste on insurance overhead and bureaucracy."
The researchers surveyed 2,134 random families who filed
for bankruptcy between January and April in 2007, before the current
They used public bankruptcy court records and survey 1,032
respondents by telephone.
While only 29 percent directly blamed medical bills for
their bankruptcy, 62 percent had medical bills that totaled more than 10
percent of family income, said an illness was responsible, had lost income
due to illness or some other medical factor.
"Among common diagnoses, nonstroke
neurologic illnesses such as multiple sclerosis were associated with the
highest out-of-pocket expenditures (mean $34,167), followed by diabetes
($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178),
and heart disease ($21,955)," the researchers wrote.
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By MELINDA DESLATTE
Associated Press writer
A bid to do away with the near-automatic pay raises that thousands of Louisiana government workers are slated to
receive next year failed to gain support Wednesday by the commission that
oversees the employees.
The state Civil Service Commission stalled action on a
proposal that would prohibit the 4 percent "merit raises"
for the upcoming 2009-10 budget year as a way to help the state save money.
A group of lawmakers in the state House of Representatives
have pushed to strip the raises out of next year's budget, saying the state
can't afford them while making deep cuts to state services and arguing too
many workers get salary hikes without comprehensive performance reviews.
The idea prompted angry outcries Wednesday from state
workers who said the raises were based on annual evaluations. They said
removing those raises would harm morale and take away the ability to recruit
and retain low-paid workers.
"We're talking about streamlining state government.
Why is it always on the backs of state employees?" said Leonel Hardman, president of a Louisiana chapter of the American
Federation of State, County and Municipal Employees.
The Department of Civil Service, the state's human
resources agency, recommended suspension of the pay raises in the upcoming
fiscal year for the "classified" state employees it oversees -
nearly 63,000 workers who are not political appointees deemed
"This proposal was not made lightly," said
Shannon Templet, civil service director, describing
22 states that have cut pay for their workers and 17 states that have frozen
The action needs approval of the Civil Service Commission,
however, before it can take effect.
Burl Cain, vice chairman of the commission, urged deferral
of the proposal, saying it needed more study. Three other members of the
commission agreed - the majority needed to stall the idea. Two members of the
commission didn't support the motion, in a vote that was taken by a show of
The commission could revisit the idea at a later meeting,
but that likely would be after the Legislature has finished constructing next
The panel did back changes to civil service protections
for workers, but only after the proposal was softened.
As approved, the changes rework layoff rules that give
preference to state government employees solely based on seniority to allow
agency heads to consider performance evaluations as well as seniority when
making layoff decisions.
Cain objected to those changes, which workers argued could
leave them subject to political hiring and firing decisions.
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Greater Baton Rouge Business Report | 06.01.09
By Steve Clark
Kerry Drake, CEO of Wright & Percy Insurance, is
afraid the Obama administration’s plan to reform health care is unhealthy not
only for his industry but also the country.
A major aspect of the firm’s business is helping employers
sort through health insurance options and deal with claims and administrative
issues. A scenario in which the federal government completely takes over
health care, and his firm’s services are no longer required, would be very
bleak from Drake’s perspective.
In short, it would be devastating for the industry. And
while President Barack Obama has repeatedly said he rejects a British-style,
single-payer government system and that no specific legislation has been put
forward, Drake believes the final result—no matter what officials say—is going
to be exactly that type of system.
“The end game is a single-payer system,” he says. “My
biggest concern is nobody really knows that.”
How could this happen? Through the back door, Drake says.
The drive to reform health care is fundamentally about increasing access to
insurance for Americans. Drake thinks Congress, under the guise of offering a
choice, will create a government-run public insurance plan to be offered
through employers alongside private insurance plans that currently are
offered through employers.
The public plan—perhaps an expansion of Medicare and
Medicaid—will be significantly cheaper than private plans, however, creating
a slide in the direction of the government program, Drake believes. Younger
employees might tend to flock toward the public plan, leaving older and
possibly less healthy employees with their private plans.
“It’s going to create this adverse selection, and over
time everybody will be on the public plan,” Drake says. “They want a
single-payer system. Now they’re not going to publicly say that, but it will
become a single-payer system. I don’t know how many people want a 100%
government-run health plan.”
The result of such an uneven playing field will be
rationed and restricted access to health care, he says. It’s not an
inevitable future, though it’s probable the country will have some kind of
national health plan by October.
The possibility that Congress could use a legislative
process known as “reconciliation” to avoid a Republican filibuster while
pushing through health care legislation is worrisome, Drake says.
At the same time, he’s convinced “something needs to be
done with health care.” Drake favors “guaranteed issue,” meaning no denials
of coverage to people based on pre-existing conditions, something that’s now
“If you have guaranteed issue, that means everybody will
have 100% access to coverage, either through their employer or through an
individual plan,” he says.
Drake also favors government-mandated coverage, which
creates incentives for everyone to get insurance either through their
employer or an individual plan, and penalties for not doing so. That’s
basically what Massachusetts
is doing with its plunge into health care reform.
“If you’re going to force coverage,” Drake says, “you’re
going to have to do something.”
Gil Dupré, executive director of
the Louisiana Association of Health Plans, says nervousness is understandable
cooks up sweeping policy changes. But he’s not convinced the government is
gunning for a single-payer system, even if there are some congressional
members who would do it that way if they had the chance.
“I don’t think were dealing with a situation where we can
point to Washington
and say they’re definitely trying to implement a nationalized health system and
we’ve got to do something right now to stop that,” Dupré
While incremental reform over a number of years could be
interpreted as moving in the direction of nationalized health care, we’re not
at that point yet and it’s not what Washington
is proposing so far, he says. Dupré thinks there’s
more interest in a public-private partnership, perhaps an expansion of
Medicare Advantage, in which private health plans contract with the federal
government to provide an alternative type of plan for those who don’t have
access to regular insurance for whatever reason.
Butch Passman, executive
director of the Louisiana Business Group on Health, thinks a public-plan
option is definitely in the works. He says existing public plans like
Medicare, by ratcheting down reimbursements on what they pay doctors and
hospitals to treat patients, create “cost-shifting”—making up the shortfall
charging more to those covered by private insurance.
“I often tell people who swear by Medicare that if
Medicare wasn’t able to shift its costs, you wouldn’t be nearly so pleased
with it,” Passman says.
He expects fewer benefits, more rationing and more
out-of-pocket expenses with the implementation of a government-run health
plan. Because the government has such massive leveraging power in provider
rate negotiations and contracting compared to private health plans, a public
plan would be cheaper to run—placing private plans at a disadvantage, he
“That, in fact, creates a hidden tax to the rest of us,” Passman says.
Dr. Roger Smith, chairman of the neurosurgery department
in New Orleans
and president of the Louisiana State Medical Association, says Obama
campaigned on the concept of the existing employer-based insurance market to
get insurance coverage to more people—though this is subject to debate even
among the largest employers.
He doesn’t believe Obama has a single-payer system in
mind. That said, establishing a nationwide public insurance program—perhaps
by lowering the threshold of Medicare eligibility by 10 years—could
potentially be “the most destructive to the insurance industry” among the
various ideas being floated, Smith says.
While many physicians nationwide support a single-payer
system, LSMS favors a competitive, market-based system, with the realization
that some percentage of Americans will have no choice but to have insurance
from a government plan. He does see the necessity for some regulation of the
insurance industry—something even the industry itself prefers to being forced
to compete with a lower-priced public plan.
“What we would hope to see is that all Americans would
have health insurance and access to their physicians and hospitals and other
providers,” Smith says, “that it would be done in an equitable, fair way of
choice for patients and freedom of choice for physicians to practice what
they want and not be regulated to the point where medicine suffers.”
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The New York Times | 06.04.09
By PAULINE W. CHEN, M.D.
I would like to believe that my care is
“patient-centered.” I try, for instance, to begin my visits with patients by
asking how I can help. And I try not to leave an exam room without setting
aside time for anything patients might feel I did not address.
But a couple of weeks ago, Dr. Donald M. Berwick, made me
wonder if I should do more.
Dr. Berwick, a Harvard pediatrician and President of the
Institute for Healthcare Improvement in Cambridge,
Mass., is a leading authority
on health care quality. Last month in a national health policy journal, Dr.
Berwick published an article titled, “What ’Patient-Centered’ Should Mean:
Confessions of an Extremist.” In it, he writes that the United States will require health
care systems that are radically different from most of the ones we have today
if we are to deliver truly patient-centered care. These systems would
transfer control from doctors to the patients themselves.
Some examples of this new model of care? Shared
decision-making would be mandatory in all areas of care, with patient
preference occasionally putting evidence-based care “in the back seat.”
Patients and families would participate in the design of health care
processes and services and would be a part of daily rounds. Medical records
would belong not to clinicians but to patients, who would no longer have to
get permission to look at them or call the doctor for lab results.
Even the word “compliance” would become obsolete.
As Dr. Berwick writes in his piece, “[We] would all be far
better off if we professsionals recalibrated our
work such that we behaved with patients and families not as hosts in the care
system, but as guests in their lives.”
I called Dr. Berwick recently to discuss his definition of
patient-centered health care, the effect of such a system on doctors, and
actions patients could take now to improve their care.
Q. Do you think “patient-centeredness” exists in current
health care practice?
A. If you are interested in quality, you have to be
interested in patient-centeredness. Good doctors and nurses do try mostly to
focus on every patient as an individual. But we have built a system around
clinicians that makes it impossible to customize care the way it needs to be.
We don’t have a standard of services or processes that are comfortable for
patients. We have built a technocratic castle, and when people come into it,
they are intimidated.
Patients keep having to repeat
their name because the system has no memory. We dress them in silly-looking
gowns. We give them the food we make instead of the food they want. We don’t
let them look into their medical records unless they have permission. Health
care keeps telling patients the rules instead of asking patients about their
individual needs. What is said is, “This is how we do things here,” not “How
would you like things done?”
People get accustomed to this. They are trained to be
passive, and passivity is not a good idea. Studies have shown that people who
are trained to be proactive do better and feel stronger. They have more pride
and trust in their own capabilities.
When you make someone helpless, in a funny way you make
them sicker, even if all you cared about was just the body.
Q. What if a patient’s preference is in conflict with
recommendations grounded in evidence-based medicine?
A. I would treat it as a challenge of information
exchange. Human beings have got to have the ability and the responsibility to
make their own decisions. As long as they know everything they need to know,
they should be able to make the decision. If we doctors feel a person is
going to make unwise choices, we have to take on the responsibility of being
teachers, educators and informers. We need to give people all the knowledge
and information so they can make their decisions well.
And we don’t do that well at the moment. It’s often done
as a relatively pro forma matter.
Q. Tell me about your views on “noncompliance.”
A. I think “noncompliance” is a control word, a power
word, and we need a slightly different one. “Compliance” means I order and
you either do it or not; you obey. Patients live in their bodies and may know
more than the person who prescribes or does their procedure. They may know
better about what is going on in their body and about the optimization of
their own life. I think people who aren’t taking their own medicine are
telling us valuable information about their medications and their life, and
we need to listen to them.
Q. Many clinicians already feel stretched to their limits.
Will creating this kind of patient-centered health care system add to the
stress on physicians?
A. When you are in a position of having to deny and
exclude patients, it is draining on the spirit. I actually think the mode I
am counseling would be more satisfying or joyous for caregivers. Not all of
the time or always, but it would be a better place to be. You would be
putting yourself at more of a level with the patient, as more of a peer. And
you wouldn’t have to carry on as if you were mythical. Medicine is imperfect
and doctors know that.
Q. What can patients do to encourage more patient-centered
A. Know more about what’s happening to you. It stuns me
that people don’t know what medicine they are taking. Know the name of your
medicine and what it does to you. If you are getting a procedure done, know
the procedure. Medicine is not nuclear physics. Most adults and kids can
basically understand. There can be uncertainty in medicine, but if there’s
mystery, something is wrong.
Speak up and be prepared. From research we know that
patients who write down questions do better. Bring your digital recorder into
the meeting so you can listen to the conversation several times after. Bring
a companion along to be your sentinel, your advisor.
In the end, if you are being cared for by a doctor or
nurse who doesn’t give you what you feel is choice or control, find someone
else. But only if you want that. Some patients don’t want that and it’s a
perfectly good choice, too.
Q. And doctors?
A. Remember why you went into this profession in the first
But the burden to change the system falls on the leaders,
the stewards, the people who create the
organizations where the workforce works. Doctors want to do their work in a
patient-centered way; they really do. We have to fix the health care system
so that it gives doctors the time to do the job they want to do.
Join the discussion on the Well blog, “Giving Patients
What They Want.”
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The New York Times | 06.03.09
By ROBERT PEAR
— President Obama said Wednesday that he was receptive to Congressional
proposals that would require Americans to have health insurance and oblige
employers to share in the cost. But he said there should be exemptions for
people who cannot afford insurance and for small businesses in general.
Mr. Obama set forth his views in a letter to the chairmen
of the two Senate committees writing health care legislation, Max Baucus of Montana and Edward M. Kennedy of Massachusetts, both Democrats.
The president said he was open to proposals for “shared
responsibility — making every American responsible for having health
insurance coverage, and asking that employers share in the cost.”
He did not use the terms “individual mandate” and
“employer mandate,” which suggest a degree of coercion that Democrats try to
avoid implying. Still, the letter provides the fullest statement of Mr.
Obama’s views on proposals at the heart of legislation to cover all
Americans, his top domestic priority.
“If we are going to make people responsible for owning
health insurance, we must make health care affordable,” Mr. Obama wrote. “If
we do end up with a system where people are responsible for their own
insurance, we need to provide a hardship waiver to exempt Americans who
cannot afford it.”
Moreover, the president said, “while I believe that
employers have a responsibility to support health insurance for their
employees, small businesses face a number of special challenges in affording
health benefits and should be exempted.”
To help pay for coverage of the uninsured, Mr. Obama
called on Congress to squeeze $200 billion to $300 billion from Medicare and
Medicaid over the next 10 years, on top of the $309 billion in savings he
proposed in his budget. Such cutbacks are sure to face resistance from health
care providers who would be affected.
Mr. Obama’s letter affirmed his support for creation of a
new government-sponsored health plan.
“I strongly believe that Americans should have the choice
of a public health insurance option operating alongside private plans,” he
wrote. “This will give them a better range of choices, make the health care
market more competitive and keep insurance companies honest.”
Republicans say a public plan could drive private insurers
from the market and lead eventually to a single-payer government-run system.
They said Wednesday that if Mr. Obama insisted on a public plan, he could
wreck the chances of enacting a bipartisan bill.
The president’s letter reaffirmed his “determination to
enact a government-run health plan that would raise taxes and ration care,”
said Representative John A. Boehner of Ohio,
the House Republican leader.
But Richard J. Kirsch, the national campaign manager of
Health Care for America Now, a consumer group, said he was “thrilled to see
President Obama’s strong, unambiguous support for a public health insurance
Administration officials said the letter reflected the
evolution of Mr. Obama’s views since the election last year. In the
presidential primaries, Hillary Rodham Clinton supported requiring everyone
to carry insurance. But Mr. Obama said then that the requirement for coverage
should at first apply only to children.
The idea of a child-only mandate has not found significant
support in Congress, where Democrats favor an individual mandate, with
federal subsidies or tax credits to help defray the cost of insurance for
people with low or moderate incomes.
The waiver proposed by Mr. Obama is similar to that in Massachusetts, which
requires all adults to have health insurance but offers exemptions to people
considered unable to afford it.
This year, for instance, Massachusetts considers a premium of $232
a month to be affordable for a family with annual income of $45,781 to
$54,936. If residents in that income range cannot obtain a premium that low,
either through an employer or in the individual insurance market, they
qualify for a waiver. In 2007, the plan’s first year of operation, about
residents were so qualified.
In Washington, senior
House Democrats, including the majority leader, Representative Steny H. Hoyer of Maryland,
have said the House bill will include some type of public plan option.
Senate Democrats are by no means unified on that idea, and
a group of fiscally conservative House Democrats expressed concern on
Wednesday about some proposals for a public plan.
The group, the 51-member Blue Dog Coalition, said the
public plan should be available only as a backup, if private insurers did not
rein in costs and offer affordable coverage to everyone.
Even then, the Blue Dogs said, the public insurance plan
must not be a replica of Medicare, the government-run health program for
older Americans; must not use Medicare rates to pay doctors and hospitals;
and “must adhere to the same rules and regulations” as private insurers.
“No one knows what the public option will or will not be
able to achieve,” said Representative Mike Ross of Arkansas, a Blue Dog leader. “Frankly,
it’s an experiment. We cannot create a public option that stacks the deck
against a system that currently provides coverage to more than 160 million
Mr. Obama said he was “committed to working with the
Congress to fully offset the cost of health care reform,” by curbing the
growth of Medicare and Medicaid and “by enacting appropriate proposals to
generate additional revenues.”
The president did not comment on proposals to tax some
employer-provided health benefits, an idea favored by Senator Baucus but
opposed by labor unions and many employers.
Kevin Sack contributed reporting.
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The New York Times | 06.03.09
By KEVIN SACK
ROCKY MOUNT, N.C. — A year or so ago, when customers
buttonholed the pharmacists at Almand’s Drug Store
here the questions were invariably about dosing or side effects. These days,
they are almost always about cost.
Can I get this as a generic? Is the co-pay really that
high? Will you match Wal-Mart’s $4 price? “I’m out of Lexapro,”
a woman pleaded one recent Tuesday, speaking of her antidepressant. “Can I
just have four pills until payday on Friday?”
Some customers request prices for a fistful of
prescriptions, and then say they can fill only the cheapest two. Others ask
which are most important.
“It can be a hard question to answer,” said Traci W. Suber, the head pharmacist. “The only thing I can do is
let them know what they’re for, get them the cheapest available and encourage
them to come back for the others when they can.”
Even with the Medicare drug benefit, even with the
prevalence of low-cost generics, even with loss-leader discounting by big
chains, many Americans still find themselves unable
to afford the prescription medications that manage their life-threatening
In downtrodden communities like Rocky Mount, where unemployment has doubled
to 14 percent in a year, the recession has heightened the struggle. National
surveys consistently find that as many as a third of respondents say they are
not complying with prescriptions because of cost, up from about a fourth
three years ago.
Many customers at Almand’s
Oakwood neighborhood store, particularly those too well off for Medicaid but
unable to afford insurance, simply pick and choose
among risks. They weigh not taking maintenance medications against more
immediate needs like shelter and food.
The pharmacists see it every day. About eight months ago,
they stopped automatically preparing refills for regular customers because
they found that more than half were not being collected and had to be restocked.
One recent Wednesday, James S. Crawford, newly discharged
from the hospital after his third heart attack, fanned six green slips across
the counter as if showing a hand of cards. There were a pair for high blood
pressure, one each for angina, cholesterol, and acid reflux, and a renal
vitamin for his kidney disease. “I need to know the prices,” he said.
Ms. Suber, the pharmacist,
explained what each drug was for and listed the co-payments under Mr.
Crawford’s Medicare plan, ranging from $8.25 to $18.49 for a one-month
supply. The renal vitamin, at $21.89, was not covered.
Mr. Crawford, 61, who makes do on $1,800 a month in Social
Security and veterans’ benefits, decided he could afford only the heart,
blood pressure and acid reflux pills. “If I can rob a bank,” he said,
chuckling, “I’ll be back for the others.”
Before leaving, he handed over yet another prescription,
just for safekeeping. It was for Plavix, an anticlotting drug that helps coronary patients avoid new
blockages, and it had been written in early February after Mr. Crawford’s
second heart attack. At $160, the co-payment was so high he had never
considered filling it.
Some customers get by through a patchwork of assistance
programs offered by governments, charities and drug makers. The only hospital
in Rocky Mount,
Nash General, donated about $60,000 in medications last year, and a newly
established free clinic is spending up to $600 a month on discounted
prescriptions at Almand’s.
But the need is much greater, and the impact is already felt
downstream in clinics and emergency rooms where the ailing seek
treatment when their diabetes or blood pressure spikes out of control.
Dr. John T. Avent, a physician
at a low-income clinic near Almand’s, estimated
that at least 80 percent of his patients were not taking prescribed
“They’ll say, ‘Well, Doc, I just couldn’t afford it; I’ve
been out of it for a month now,’ ” Dr. Avent said.
“By that time, of course, their blood pressure is highly elevated and their
hemoglobin A1C is two to three times what it should be.”
Dr. Daniel C. Minior, who
directs the emergency department at Nash General, said he was increasingly
hearing from patients that they had lost jobs and could not afford
medications. “The worrisome aspect is that it’s even occurring among younger
and working-age people,” Dr. Minior said. “That’s
not something we saw before.”
Rocky Mount, planted amid
tobacco fields in eastern North
Carolina, has seen the closings of mills and an
exodus of jobs, compounding the devastation caused by flooding from Hurricane
Floyd in 1999. The Almand family once owned a dozen
pharmacies in the area, but only two survive.
The Oakwood store, in the heart of the African-American
community, faces growing competition from mail orders. But business remains
steady thanks to discount programs, partnerships with neighborhood clinics,
while-you-wait service, $1 delivery and a friendly, familiar staff. Each
morning, the pharmacy fills with the aroma of popcorn from the machine on the
counter and Gloria Mabry, who runs the cash register, greets customers by
calling them Baby or Sugar, whether she knows them or not.
More than 70 percent of the store’s patrons are covered by
Medicare or Medicaid, and the pharmacy offers $4 generics to the uninsured.
But customers taking a dozen or more medications may still struggle to afford
even the modest co-payments under government plans (as low as $3 in the case
Lisa A. Hylton, 29, from nearby
Sharpsburg, said she had skipped twice-monthly refills three times this year
on an albuterol inhaler for her asthmatic son,
Hunter. Her husband, a pipefitter, had been working only intermittently and
could not afford insurance during the idle stretches, Ms. Hylton
said. “It makes me feel like I can’t supply for my young-uns.”
Jimmie L. Bryant, 56, had been laid off for a month when
he walked into Almand’s with swollen glands and a
one-time voucher from the Edgecombe County Department of Social Services. For
the first time since he lost his job, the voucher enabled him to fill
prescriptions for Synthroid, to control his
hypothyroidism, and Xanax, for depression.
Mr. Bryant said he had tried to get refills from his
physician, but was told he would have to schedule an office visit for $120,
which he could not afford. Even when he was working and had insurance, Mr.
Bryant said, he would alternate between the two prescriptions, week to week.
“At the end of the month, I’d have a little bit of what I
need in my system,” he explained.
Similarly, Robert E. Brown, 60, who has heart disease and
emphysema, said he regularly told the pharmacists at Almand’s
to reshelve his prescriptions after being quoted
prices of $100 or more. “I just hand them back,” he said. “I take the ones I
can afford, and then trust in the Lord.”
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