Long ago, I said that every problem the United States is currently facing can be found in acute abundance in New Orleans. Solutions to the issues that plauge this city will be replicated in other cities around the country, or so the theory goes. This means New Orleans is called a "laboratory" in many aspects of civic culture: the local schools, entreprenuership, green housing and health care.
(If anyone remembers, we talked about this specific issue with the Health Care panel at Rising Tide 4.)
One of the things ballooning health care costs nationwide is that uninsured or indigent patients use Emergency Rooms as their primary care outlets. This is very expensive and time consuming - and full emergency rooms just exacerbate the process - but for many individuals this is the only choice. One huge area of government health care spending is covering hospitals who treat patients who cannot pay.
This was a big deal in New Orleans, where Charity Hospital was the big, public hospital where anyone could go to see a doctor. I think Atlanta has something similar with Grady, as this model was replicated across the country.
With increasing health care costs, this model becomes unsustainable and has been for some time. Charity Hospital (or any big public facility) wasn't the problem, it was the way its Emergency Room was being used as a primary care facility, which is not the purpose of an ER. Without a serious change to the local health care systems and culture, this will be a problem with any new LSU Teaching Hospital that gets built.
The solution (or at least the most current viable solution) is to increase the number and support of community primary care clinics. When folks have a doctor they can go see and develop a professional medical relationship with, and when their records are clearly kept, they will not go to the ER for primary treatment, and health care costs will contract. Also, with access to primary care, patients are more likely to recieve preventative care, also working to contract health care costs.
We desperately need this kind of reform in New Orleans, and all over the South. I am glad it seems to be recieving bi-partisan support, and I'm very glad that administration officials approved the changes.
This is a part of health care reform that you don't hear about on the squawk box.
Meanwhile, in the DC laboratory to reform public schools, Michelle Rhee's controversial and autocratic reign has come to an end. Being one of the smartest kids in the room, she will of course land softly before getting a high paying job at a think tank or news organization, but we need to look carefully at what went wrong. Leadership is about more than book smarts and pet theories - you have to play well with others, abandon assumptions and empathize with your opponents if you want to enact long lasting, deep reforms that end up working in the long run.