Venal Politics of Ambition, Ideology, and Contributions Crippling Louisiana Healthcare

New Orleans  What often goes unsaid when the right pontificates and proselytizes about the wondrous benefits of privatization or public-private so-called “partnerships,” is the how much this is all simply a rationalization for personal ambition and the need to raise huge campaign contributions to fuel that fire.

We see this now, painfully and almost daily, in Louisiana while watching the gyrations of Governor Bobby Jindal to cripple the healthcare and educational institutions in the state that go back literally to the days of Huey Long.  His naked ambition as a wildly long shot aspirant for higher office means that he has to raise huge money to campaign and it is easy to tell his desperate strategy is two-fold, by first appealing to the rich ideologues pulling the Republican tail these days and secondly, asset-stripping by leading a giveaway of the state’s long established public hospital system to unnamed private hospital corporations for huge expected later contributions.

On his way out of town for another fundraising and headline hoping trip, Jindal announced his budget proposal.  Of course more cuts for higher education which has endured 5 straight years of reductions, which will force tuition increases.  Jindal wants to avoid having to own the responsibility by having his people claim that tuition increases will be at the decisions of the individual boards and chancellors.  Yeah, right!   In health care Louisiana once led the country in establishing public hospital care, but now Jindal is dismantling the system wholesale.  Of the ten remaining public hospitals within the LSU system, five have already been forced into public-private partnerships.  Two others have guns to their heads.  The hospital in Monroe in the northern part of the state was only put in the budget for the first three months of the new fiscal year.  Seems like that would be a hard message to miss if the hospital administrator was hoping for better bargaining chips in negotiating with private hospital companies, but the budget bullet puts pressure for little more than a cave-in with the governor to thank.

The billion dollar new hospital finally being built in New Orleans where we have been a healthcare desert since Katrina now worries that all of the numbers were wrong on their projections for operating budgets for the facility, since they had calculated them on the assumption that healthcare would be expanding through the Affordable Care Act (ACA).  It had never occurred to these state, city and federal healthcare planners that a far right ideologue in the governor’s chair would deliberately deny a free expansion of healthcare for uninsured citizens in our poor city and region.  Of course Jindal a captive of the Koch types, preferring to be consistent rather than right, literally answers the question of reconsidering his decision in the wake of other Republican governors recanting by laughing.  It’s the kind of response you would probably expect from someone who has also now devastated the prospects of mental health assistance in the state that might have benefited him personally.

Where did this notion come from that public assets and institutions are simply commodities that can be traded away at the whim of individual politicians?  The pretense of public service has to include restraint when embarking on destroying institutions that are hundreds of years standing and critical to citizens, especially those without alternatives.  The road to privatization has long been paved by campaign contributions from the benefiting parties, and certainly none of us are naive in thinking that big time politics is other than big time business.  A governor or politician of any persuasion in this time where money plays such an outsize role can only expect thanks from citizens for continuing to provide first class public services, but contributions flow freely when public assets are transferred to private parties in the name of whatever.

Meanwhile in this crony capitalism of Louisiana’s healthcare assets, the State of Louisiana will still pay for the privately managed outfits to provide service to the citizens creating a future spiral of state cutbacks to these outfits for declining care for the citizens, until they walk away as well, but that is long after Jindal’s term has expired.  How do they live with themselves?

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For the Poor the Supremes Have Brought the Fight for the Affordable Care Act Back to the States

New Orleans     The great news is that Chief Justice John Roberts looked over his shoulder at history and found a way to provide the needed vote to uphold President Obama’s signature legislative accomplishment and rule that the Affordable Care Act (ACA) was constitutional yesterday.  The decision is surrounded by dark clouds and rests on somewhat shaky ground, as I read some of the analysis and commentary, but lawyers and legislators will bring us those fights in the future.

The fight now falls in two places.  First the ACA has no chance of surviving in any form or fashion without putting Obama at the goal line to insure that any attempt to repeal is vetoed, and furthermore the numbers have to be bucked up to prevent an override of any veto.   That’s an all hands on board matter for all of us:  dateline November.

The other fight is even messier though, and that’s the one that has to do with expanding real coverage for the poor.  For many of us the best thing about the ACA and what made it worth swallowing some of our hopes and dreams for the fight was the very expansion of Medicaid at the state levels that was embedded in the Act.  Now, tragically, the convoluted decision has this expansion voluntary, in a shocking move by a disturbing majority (7-2), which moves the notion of “states’ rights” from atavistic, rightwing rallying cry to commonplace future policy concern for any new piece of legislation in the future.  Immediately it means that the 26 states that joined to bring the challenge to ACA could individually decided to block the expansion of healthcare coverage to the poor and the federal government, having lost the ability under this decision to withhold funds for such action, will be powerless to prevent them from doing so.

Louisiana, where I live, leads the list of states with poor families who will be punished in this way, just as current Governor Bobby Jindal has been doing to date.   The 26 states include the whole block of the Deep South (7), most of the Mountain and Plains states (10), and surprising pack in the Midwest (5), and then a couple in the Northwest and a couple in the Northeast.  The more rabid of these states, like Louisiana and the up-south Wisconsin, have declared that they will do nothing and put all of their marbles on ejecting Obama and overtaking Congress.  In places like Washington, Pennsylvania, Michigan, Ohio, Nevada, Colorado, Arizona, Nevada, Florida, and maybe even Nebraska, I think an argument could be made that deeply state-based coalitions should be built now that could wage the ground, air, and political campaigns to expand Medicaid for the poor in those states.  Resourcing would be a struggle until the Obama election is determined probably, but where it was possible to build wider and deeper now on this issue, the fight could be joined immediately on the core issues.

There is great work already happening in many of these states – thank goodness – but this is now a clearer and harder fight than any had imagined until yesterday’s decision so it demands a deeper look and a different strategy if lower income families are going to have any chance of getting something closer to universal health care in the 26 holdout states.  We are now going to have to fight in the trenches everywhere, and there’s no federal knockout punch to win the late rounds.  Either we would have to move the poor to covered states or organize the poor to win where they live.  That’s my vote.  It’s a life or death fight.

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