Patient care not as good at for-profit nursing homes

Disappointingly, but perhaps not surprisingly, the long-awaited federal government rating system for nursing homes showed Louisiana had the highest proportion of lowest-rated facilities in the nation. A change in state policy concerning long term care can bring incentives to boost the ratings and probably save the state money simultaneously while serving more of its needy citizens.

The official reason for the high incidence of low-rated places given by the industry itself is that Medicaid reimbursement rates paid by the state make more difficult hiring sufficient staff numbers. The majority of people in nursing homes are supported by and the revenues collected by the indursty in the state are provided by Medicaid.

But other states pay lower rates than Louisiana and still manage to do a better job. The reason why is that for decades state policy deliberately has favored warehousing the elderly in nursing homes, as opposed to home- and community-based solutions to which  increasing other states have gravitated. So has Louisiana, more slowly and somewhat unwillingly, and largely as a result of the Barthelemy settlement a few years ago, but despite that the state's facilities proportion of Medicaid revenues are almost double that of the national average.

The problem is, the institutional bias in indigent elderly care has encouraged building more capacity than needed, which also costs the state more as opposed to the other solutions. Artificially made prosperous by this, operators fight constantly through political channels to prevent state policy from making changes that serve to shift funding out of institutionalized care towards the other solutions, even though the state could save considerably (a study a few years ago estimated savings at close to $100 million a year if the state made a few simple procedural changes that would match practices in other states.)

Even with this resistance, the tide slowly is turning in favor of taxpayers and those who would have better quality of life through home- and community-based care as state budgeting is beginning to shift away from the institutional solutions. Accelerating this transition not only provides better service and saves money, but can improve the quality of care in state nursing homes. The state could change its methodology to more tightly define who is eligible to be funded by Medicaid in an institutional setting, steering more people in community programs. Some money saved from this can go to funding these other programs, but some could be retained and used to boost the daily rates paid by the states for institutions. Yes, this would require retrenchment in the nursing home industry but these operators must have known for years and should have been planning for the day the gravy train would end for them.

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Done -- and to do

Before we can figure out how to assess Gov. Bobby Jindal's first year in office, we need to get straight what he did and did not do. Some seem confused about exactly what that was, while others don't seem to want to understand what that was.

Conservative watchdog C.B. Forgotston argues that in his first year, Jindal increased spending by $1 billion and the government employee headcount by 2,700. His numbers are not far off - Jindal proposed an increase in non-disaster related spending of $760 million and total state employees as of last Jun. 30 were up 3,181 over the previous 12 months - but these tend to obscure the picture somewhat. If we look at only the general fund amounts excluding that portion tied to disaster relief, that budgeted figure (which was a little less than actually budgeted but will be more than what actually gets spent) was an increase of $466.5 million or an increase of 3.31 percent. Headcount associated with this spending actually was scheduled to be down 1,035.

The general fund numbers are the best representation because they are the ones that Jindal (and the Legislature which must pass budget bills) have most control over. Most of the rest of spending and positions associated with it are tied to the federal money coming into the state over which state politicians only have partial control (for example, some is mandated by the federal government and matched to a certain extent given state actions). Of course, this does not include hundreds of million of dollars in nonrecurring state funds from the general fund's past spent in 2008's second special session with Jindal's blessing.

By this metric, Jindal did a decent job of holding spending to around the rate of inflation and, further, in the spending of federal money reduced dramatically the amount that came from nonrecurring sources which meant where state spending would have to increase in the future - such as in Medicaid where the state's share is scheduled this year will go from 28 to 32 percent of the total (which Jindal hopes will not take place, arguing the continuing disaster recovery mode justifies the lower share) - would necessitate less surprise, unbudgeted state expenditures. Whether this makes Jindal a "fiscal conservative" may be in the eyes of the beholder.

Definitional issues aside, at least Forgotston pays attention to what Jindal actually does. Others seem unable to grasp what Jindal seeks to achieve even though it is right in front of them. Jindal's most prominent leftist media critic insinuates …
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Cable TV franchises bypass local fees

Some local governments in Louisiana, conscious more than ever of revenue being squeezed, continue to resist reform legislation in cable television provision that recently has gone into effect. From the bellows emanating from the Louisiana Municipal Association and Police Jury Association of Louisiana, one would think fundamental rights of the citizenry are being violated with this law coming into force. But in the end, all it's about is local governments decrying being unable to skim more money out of the citizenry.

These groups have gone to court - and so far lost - to try to stop implementation on the new law, Act 433 of 2008. It allows for granting of statewide franchises for operators which gives far less discretion for local governments to attach on special conditions that can be used as backdoor methods to raise government revenue from ratepayers. Eager to deflect from this reality opponents of the law - who do not include the cable industry itself that once opposed but now supports the new standards - raise chimerical arguments that expose that the conflict really is about clipping local government power and not about citizens who subscribe to cable TV.

One concern presumed discrimination against rural areas because on a per capita basis it is more expensive to provide such service. This was addressed previously by the onerous "build-out" requirements most local governments forced upon providers which not only passed costs on to urban ratepayers (as rates were invariant of population density) but also provided more potential sources of pass-through revenues for local governments. The new law gives market forces much greater priority and reduces any such complaints of reduced rural service to a big "so what:" it's not like cable TV is essential to anybody's life, you don't have the right to have it and, if you really want more than broadcast choices, there's always satellite.

Another mountain-out-of-a-molehill complaint comes from local government who say they can't get freebies that they used, such as compelled coverage of their governmental bodies or free service to government buildings. The former complaint is misleading: the law compels offering service for at least one channel of "public, educational, and governmental" access automatically for any local government upon request, and at least one additional channel if local governments use it enough. Whereas governments used to force companies not only to broadcast but to pay for production of certain things, the only difference now is that providers will have to only subsidize it partially. And why should government enrich itself with free service when if the company did not have to provide it, savings could be passed on to the ratepayers?

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Facing deficit, governor announces budget cuts

Gov. Bobby Jindal swung the budget axe and largely hit some unneeded trim. More importantly, some of the cuts, triggered by a $341 million current-year deficit, began to shape things into a more fiscally sound posture that he has advertised was a priority for him in governance.

By law, Jindal could cut up to three percent of the budget with no more than three percent from any budget unit. That made up a little less than half of the projected general fund deficit (doubled in relative terms since half of the year's spending already has occurred at the higher levels) so technically the remainder of his suggestions still wait legislative approval. However, because the total deficit exceeds 0.7 percent, he also was allowed to go beyond just the fund in deficit, the general fund of which almost three-quarters of all appropriations go to health care and higher education, and make cuts in other dedicated funds - a panoply of appropriations attached to a certain revenue source or drawn from a revenue source or to satisfy a bookkeeping or legal requirement - of up to five percent.

In doing so, since these funds go certain activities, in essence Jindal told the departments with access to the funds to perform the same functions with less, absorbing a cut in operations. Although this constituted only about seven percent of the total, it increased flexibility and the necessity for the general fund to absorb everything (not all dedicated funds got the maximum cut; some didn't get cut at all). Jindal also targeted strategically cuts within the general fund programs that will constitute $317 million or so of them.

How he did it was instructive. By the ratios of general fund spending, $252 million should have been pared from health care and higher education, but targeting cuts put the final total at only about $173 million. Some of this could be achieved by the hiring freeze earlier instituted also allowed by law which reached all sectors of government, not just those dependent in any way upon the general fund, but the remainder of it did not follow what some had advised, across-the-board measures.

Smartly, Jindal used this power to promote his agenda, in a way getting an opportunity early to shape parameters of the kinds of reform he wants to bring to these areas. In higher education, for example, he backed up his assertion that the most important area of development was in community colleges and technical schools by leaving them out of the cuts.

In health care, he showed that efficiency was going …
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Wednesday, December 31, 2008

Baton Rouge, Louisiana

PERCEPTION AND REALITY IN LOUISIANA POLITICS

 In 2008, Louisiana rode the bubble.  A new Governor and a cadre of other new public officials were ready to put the Katrina mentality behind, and begin the process of bringing Louisiana fully into the 21st century.  There was a perception, stirred by continuing editorials in the state’s daily newspapers, that major changes were on the way. The word "change" was a bellwether in the Bayou state well in advance of the new president making this his mantra in his quest for the White House.  But in Louisiana, the perception of reality is often not reality itself, but our own version of it.

Few governors have come into office with the momentum of Louisiana’s Bobby Jindal.  He followed a lackluster Governor damaged by her handling of Hurricane Katrina.  Jindal effused with energy and new ideas on the state level that corresponded to the same image gushed by our new President on the national front.  He was the young, ethic alternative in the GOP that was made up of older white guys with few new ideas. Bobby Jindal’s timing was just right.

But that was then.  Louisiana was initially considered insulated form the national financial crisis due to high oil process and the billions being poured into the state for Katrina rebuilding.  But the price of oil has plummeted from one hundred fifty dollars a barrel to a current thirty four dollar low.    And the flow of hurricane recovery money has dwindled considerably.   If there is any doubt about the state’s precarious economic condition, one only has to scan the daily newspaper headlines.

“Our Oil Drunk, Our Hangover (Jindal’s Folly)” Morning Advocate-Dec. 28^th.

“Greed Came Home to Roost for La. Public Officials” The American Press- Dec, 29^th

“Higher Ed. Ranking predict Dismal Future in La.”  Shreveport Times-Dec. 28^th

“Tax breaks Worsen budget Shortfalls in La.”  The Associated Press-Dec. 29th

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LA attack feared on gay adoption

It's a clever tactic by supporters of legally-sanctioned homosexual relations, but if it is the will of the people of Louisiana, this agenda may be derailed.

As consumers of what passes as "news," observers always should wonder when something becomes declared "newsworthy" by the media that doesn't seem to have any real cause or impetus behind it. Such was this story about how a state board, after its existence of seven years, and about a year after election of socially conservative Gov. Bobby Jindal who appoints it members, suddenly has gotten worried promoters of legally-sanctioned homosexual relations.

The Commission on Marriage and Family has seldom conducted any activities, but Jindal has expressed interest in activating it and its nominal head state Sen. Sharon Weston Broome has scheduled a meeting of it. Jindal released an executive order on Aug. 22 re-establishing it. In October, he appointed its members. But only now does it seem to be drawing the alarm of some homosexual advocacy groups, which claim now it could be used as some kind of political cover for an "attack" of homosexuals adopting a child. They argue too many religious conservatives appear to be on this panel and, even though not a word has been uttered indicating any disapproval of these kinds of adoptions, that now it's something to be worried about because the people of Arkansas in November voted to make unconstitutional such arrangements and the Commission could conceivably promote a similar policy.

This is an odd rationale. The Commission can do nothing but recommend, but somehow its opponents think a pronouncement by it on the issue would engender enough political power as to sweep the state into also making unconstitutional unmarried couples being able to adopt jointly. Yet there's no real reason this has to happen: if enough of the people and political elites think this such a measure is good public policy, they don't need a commission to tell them that and get them going to achieve it.

The timing of this complaint also is extremely curious. Why complain now? If these groups had stated publicly their concerns with the re-establishment in August (with the order itself extolling the virtues of marriage only between a man and woman, overwhelmingly approved by Louisianans into the Constitution years ago), or when the Commission's composition was determined in October, or when Arkansas acted in November, that might make sense. But why go public, seemingly without warning, at the end of December?

Even more intriguing is, by law, just as same-sex marriage was ratified as unconstitutional, many years …
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Louisiana loses more clout in halls of power

The irony of it all is that as Democrats prepare to wield more power in Washington, in Louisiana the biggest loser from this will be its sole Democrat member while the biggest beneficiary will be its most high-profile Republican.

One might think Democrat Rep. Charlie Melancon might be in a good position given the takeover of the White House by his party and a stronger majority in the Congress. The fabulously do-nothing 110^th Congress run by Democrats, which when it tried to do something substantive typically sent extremist legislation blocked by Pres. George W. Bush's veto, gave Congress the lowest public opinion approval ratings in history. But with him out of the way, the floodgates may open allowing Melancon and his ilk greater leeway than ever (as long as they hold on to that power which, if they serve up the same kind of legislation they have been proposing, unless it tries to structurally change electoral politics in Democrats' favor such as by the misnamed Employee Free Choice Act, won't be long).

But his problem is that things got too good for Democrats. Melancon often argues his affiliation with the liberal Democrats, not liked by a majority in the state (and whose presidential candidate got about 35 percent of the vote in Melancon's Third District), is tempered by his fiscal conservatism. He will claim that it's not a contradiction to put him into office because he can help moderate the more extremist tendencies of his party. It's an assertion that next year he will have a much more difficult time conveying convincingly.

In the 111^th Congress, the self-proclaimed fiscal conservative Democrat "blue dogs" will have about 50 of the about 257 Democrats in the House. With a majority (assuming all present) of 218 in order to win votes, for the fiscal and in every way liberal Democrat House leadership because of absences and defectors, they won't need Melancon or his colleagues to pass legislation and therefore will not moderate it. In the 110^th, their votes were sometimes crucial but that not being the case any more, their influence will go down.

At the same time, Republican Sen. David Vitter's influence will go up, and for the opposite reason. Being in the smallest minority now than ever before, as a member of the opposition Vitter has greater freedom than ever to make a name for himself within it precisely because the …
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Jindal in 2012?

As speculation flies about potential national aspirations of Gov. Bobby Jindal, one thing often left out in the equation is the electoral calendar particularly is unsuitable for getting himself elected to a second term as governor and making a stab at the presidency in 2012.

As anyone who has paid attention to national politics over the past two years can relate, running for the presidency is a full time job starting at least two years out from the election. The 2008 election had particularly two newer trends that exacerbated the problem even more. One was the abandonment of public funding by serious presidential candidates in order to raise more money than ever, which takes additional time of a candidate, and the other was the most front-loaded primary schedule ever which mandates more work earlier in a campaign.

Senators who may oversee a few dozen people at most and whose only responsibility is to cast votes have the luxury of time to campaign while on the job, and the president and vice president have huge staffs and resources to help the president out with his far more numerous tasks (the vice president hardly has any, of course). But governors are another matter, who have to run a state and largely must keep state and national issues separate which makes their time campaigning for national office at a premium. It's no accident that since the beginning of the Depression only five sitting governors were able to get a major party nomination for the presidency and just three have won, the last being Bill Clinton in 1992.

And these governors typically have an advantage that Jindal will not - about three-quarters of them are selected in off-years for presidential elections, so that they can run for reelection and as soon as that is complete, they could pick up running for the White House. Jindal will not have that opportunity since Louisiana is joined only by Mississippi in having its statewide elections in the third year of a quadrennial presidential cycle, a year later than most. In Louisiana, Jindal could get elected in October, 2011 and then face the beginning of presidential preferences primaries less than three months later, while other Republicans will have been campaigning exclusively for the presidency for months, perhaps even years. Jindal can't, because he cannot be seen as ignoring state issues when running for reelection.

One could argue that Jindal might have that luxury. Right now, Democrat officials are whistling into a hurricane if they think Jindal will lose in 2011. Only unless Jindal proves utterly incapable of helping to fashion a fiscal solution to the current budgetary crisis would …
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Edwin Edwards

At first I thought I was reading a term paper from one of my sub-par students. No, it turned out to be an Abbeville Meridional newspaper editorial advocating the early release of former Gov. Edwin Edwards, now better know as Prisoner #03128-095, and the intellect and logic showed in demonstrates exactly why Louisiana ranks at the bottom of many quality-of-life indicators.

The rambling thesis of this appears to be that the elderly Edwards has suffered enough. A lifetime of achievement it offers as exculpatory justification. In doing so, not only does it miss the entire point of Edwards' punishment, it doesn't even provide convincing arguments that he merits commutation of his 10-year sentence.

The editorial skirts Edwards' apparent corruption in office. Instead, it advances the peculiar notion that his long service in various capacity somehow exempts him from paying the full price for his misdeeds, even going so far as to maintain proof of his overriding good work was being elected governor four times showed "he must have done something right. Voters in this state are not stupid." No comment of mine can illuminate better the "merit" of this statement and I'll leave it to my readers to ponder this wisdom without my input.

While he never was convicted of abuse of office, plenty of circumstantial evidence makes it hard to explain what the author claims is a "myth" that "Edwards made his money in politics." If he didn't make it while in office, it seems difficult to understand why Edwards was so unconcerned from what today would be illegal lobbyist cash gifts from Tongsun Park while in Congress, or why his former operative Clyde Vidrine would produce salacious revelations in his books about these things, or why during his 1986 corruption trial it was revealed that Edwards regularly visited Las Vegas casinos with suitcases full of hundreds of thousands of dollars when as governor he made in salary a fraction of the contents of one such case each year. Willing suspension of disbelief does not make for good argumentation.

It also reads a "second myth is that government in Louisiana is corrupt and that all elected officials are crooks." Insofar as this is a straw man argument - nobody seriously argues this so why waste the space refuting something irrelevant - it claims corruption essentially stops at the Orleans Parish lines. The author needs to do a little research to discover just in the past year high-profile corruption cases being decided in Jefferson Parish concerning judges and a former state senator and in Baton Rouge about the state's Read More...

Can Cao the giant-killer repeat?

With all due respect to longtime Orleans Parish stalwart Republican and former city councilman Bryan Wagner, saying GOP Rep.-elect Anh "Joseph" Cao was going to win earlier this month the majority-black-Democrat Second District without a favorable confluence of events shows less political sense than the neophyte Cao's, who acknowledges these things. Whether he can win absent these dynamics in 2010 is another matter.

Wagner, who played a major role in the Cao campaign, naturally wants to create the impression of future electability of Cao because he understands the fundamental truism (misunderstood by many) that donations go to candidates on the basis of their quality, i.e. ability to win. These resources Cao will need for a 2010 run because all the Democrats in the 2008 contest except one outraised him as of Nov. 16 in terms of both total funding and individual donations. However, it is likely when the next reports in early January are released through the general election, Cao's totals should have gone up considerably and won't be reported too far behind incumbent and indicted Bill Jefferson's.

Let's not kid ourselves over why this was the case: Jefferson was viewed by many, even by some who voted for him, as corrupt, discouraging electoral and monetary support. Some portion of these people, as shown previously, who had supported Democrats against him twice unsuccessfully in the party primary and runoff, while they could not bear to vote for a non-Democrat in the general election did not vote for Jefferson thus at all. But an underreported aspect of the election was the fissures in the black vote that had begun to appear in the Democrat runoff primary in black support for Jefferson spread more forcefully in the general election.

As previously noted, in the runoff estimated black support (calculated by Jefferson proportion of the vote less proportion black registration) for Jefferson dipped to about 89.5 percent against a Hispanic opponent. It further dipped in the 142 precincts with at least 90 percent black registration to less than 85 percent, precincts on average only voting about 80 percent in Jefferson's favor (in several, he barely pulled an estimated 70 percent of the black vote). (Contrast this with the five 90 percent-plus white precincts that gave Cao an average 92 percent of the vote, where he got an estimated 95 percent of the white vote.) Simply, an unusually high proportion of blacks abandoned a black candidate in favor of a Republican, and it's hard not to conclude it was more the scandal-tinged Jefferson than Cao's campaign that triggered this significant exodus.

So Cao …
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