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The group submitted a redesign proposal on October 20^th, 2006.  The plan would shift much of the care provided in Charity’s inpatient setting to “medical homes” that offer “health promotion, disease prevention, health maintenance, behavioral health services, patient education, and diagnosis and treatment of acute and chronic illnesses.”  The strategy is to reduce hospital utilization and therefore costs by increasing coordination between primary and specialty or tertiary care. Patients like the one Jeff Wellborn delivered to the West Jefferson ER would have access to treatment and medications before the police pick them up in the middle of the night. Uninsured residents would also enjoy more access to health care in their own community, and their doctors could address many illnesses, such as diabetes, hypertension, or depression, before the diseases created an emergency. 

The plan would also expand eligibility for publicly-funded insurance for most low-income residents, including those with serious mental illnesses.  The price tag for the reform proposal was over $500 million.  A range of public funding sources, including a desired infusion of federal funding, would finance the expanded coverage.  Critics of the plan, however, argue that it would surpass the cost of providing access through the old Charity system.  Furthermore, while the initiative allows for the continued presence of a public hospital in downtown New Orleans, it does not expressly address the issue of rebuilding Charity.  In January 2007, funding for a joint Charity-VA Hospital received initial approval from the Louisiana Recovery Authority, though it strongly encouraged a smaller facility that complements the Collaborative’s system-wide recommendations, and the hospital complex still needs legislative and federal approval.

 Increased coverage will address the issue of parity in health care access, something lacking in the former “two-tier” system.  According to a recent PricewaterhouseCoopers report, The Quality Conundrum, most Americans think ‘equal access’ is the number one quality indicator for sustainable health care.  Byron Harrell, former CEO of a New Orleans hospital, opines in a Times-Picayune editorial, “Countless times, people with nowhere else to turn found a medical provider at Charity Hospital.” People with somewhere else to turn—i.e., the insured—almost always went somewhere else.   

The op-ed concludes, “Having a flexible insurance system is not nearly as strong a commitment to our neighbors as the physical presence of real facilities with medical care being delivered by real professionals.”  Well informed critics of the new plan, like Mr. Harrell, may be reacting to the binary decision that LSU and the Collaborative have posed to the public through their constant friction.   They have asked us to choose either Charity or an insurance plan that is underdeveloped and under-funded and they have made it an “us or them” equation. 

New Orleans probably needs the institution of Charity to return in some form, but it cannot be the only safety-net option for the uninsured.  If Charity reaches capacity or is forced to close for unpredictable reasons, the continuum will break again.  A more equitable distribution of public funding for the uninsured and the services this population uses across hospitals of all types, as well as more extensive health coverage throughout the population, will deliver more equitable, cost effective care.

In making our decisions about the city’s health care system in the wake of Katrina’s floods, we should take these three lessons to heart: New Orleans’ health care crisis reflects a lack of coordination and flexible funding and is not simply a supply shortage; the health of a population depends on consistent access for all patients; and a good solution in health care must be sustainable.  Of course, ‘sustainable’, is a bloated word in New Orleans; health care must endure fiscal mismanagement, crime, poverty, and water up to 2.4 meters.  One thing that Katrina proves is that water-resistant health care isn’t just a brick building—it might be a plastic insurance card.

Chris Weaver is a former member of the Catholic Charities of New Orleans and is currently a journalism student at the University of Maryland. Adele Shartzer works for the Kaiser Family Foundation.