The Honorable Mike Leavitt, Secretary of Health and Human Services


New Orleans, Louisiana


October 16, 2006

Remarks as Prepared at Louisiana Redesign Collaborative

I wish once again to express my admiration for the tenacity I have witnessed as the people of Louisiana work to recover from Katrina. Rebuilding the health care system is a vital part of that, and I know everyone is working extra hard.

Without recounting each step, I want to acknowledge that the collaborative continues to make good progress and express appreciation to Fred and all of you who are devoting so much time and energy.

Collaboration is hard, messy, and absolutely indispensable in solving hard, complex problems like this. As they get closer and closer to the deadline you have set, the problem can begin to feel heavy and unsolvable. Today, I want to express optimism and hopefully some clarity.

The common purpose that unites this effort is improved health care for the people of Louisiana. As a beginning point, we agreed on the vision spelled out in the principles contained in the charter. As we struggle through the hardest part of this effort we must not lose that vision.

The Charter’s principles called for a future where government health care dollars support people getting insurance rather than supporting institutions. People can then choose the most efficient, most convenient providers. That means doctors and hospitals succeed by providing better health care at fair prices. Quality improves and prices remain affordable.

Can we make the vision we started out with work financially? I believe we can. Based on advice I’m getting from experts who deal with Medicare and Medicaid systems all over America, I believe the combination of the current dollars already being spent in the Louisiana health care system and savings that come as costs grow more slowly can provide access to affordable health insurance for those who are now uninsured and need help.

There are proposals being offered by former Senator Breaux, the Louisiana Medical Society and others that I know most of you have seen but have yet to be considered by the Collaboration. Likewise, there are other states you can borrow from.

The difference we can make in the lives of people is profound. For decades people have waited in emergency rooms to get health care. Instead, we can help them have health insurance that includes access to preventive care in their neighborhoods. That was our vision.

Staying with the two tiered system believing that people are used to it and that they have learned to live with the evident shortcomings would be a tragic error. This is a profoundly important moment that history has provided to improve the lives of Louisiana families.

If we fund institutions rather than treating patients, the institutions always get taken care of, the people don’t. Money needs to follow the person, not the institution.

Once a design has been approved by the collaborative, we can validate with national experts that we have enough money. There is every reason to believe that not only will we have enough, but this approach may free up resources that can serve the people of this state in other ways.

I want to bring clarification to a couple of other questions. First, the question of whether HHS is willing to invest money in a new system. Federal taxpayers pay for nearly 60% of all health care services in the New Orleans area. We have every reason to want this done well.

The phrase “budget neutrality” has been used in conjunction with the Federal role in this discussion. Some have interpreted that to mean that the Federal government isn’t willing to invest money in this project. Not so. Budget neutrality means that if the United States government is going to invest money in the short run, we have to be confident that it will pay off in the long run, say five years.

There has been a lot of speculation about LSU and the Charity Hospital system, and particularly about plans for reconstruction of a hospital here in New Orleans. LSU is an indispensable part of health care in Louisiana. They have been in the past; they will be in the future. However, when one redesigns an overall system that’s flawed, it is necessary to consider how every significant asset will fit into the new system. It doesn’t make sense to me that you should start laying bricks until you know what you need. The construction of any new facility should be coordinated with the larger plan for reshaping the health care system that is being developed by the collaborative.

We have all agreed that a medical home should be part of this proposal. That term can mean different things to different people. To me, a medical home doesn’t have to be the same for every person. Some patients will choose a community health center, others may want a primary care physician, and some will choose a clinic.

Earlier in the year, I met several times with representatives of the health care community. I met with the Governor, the Legislature, and members of the Congressional delegation. When we met to jointly commit ourselves to this task, I’m sure all of us foresaw this moment when things would get hard, when we would be confronted with the hard choices of change.

At each of those previous meetings I made three commitments to you. First, I promised you that if we could use this historic moment to make things better for generations of Louisiana families by coming up with a demonstration waiver representing a plan that meets the principles we agreed on, that HHS would be here to help and bring resources with us. I stand ready to keep that commitment.

Second, I committed that when the hard part came and difficult decisions had to be made, I would not lose sight of our vision. I promised that if I was presented with a model waiver that does not capture the noble aspirations this tragedy inspired in us, if you send me a waiver that falls short of the generational change we all so desperately want, that I wouldn’t sign it.

Lastly, I committed that I would always remember that this is a decision for the people of Louisiana to make. Ultimately, the people of Louisiana have to decide. It’s up to you.

The first time most of us met, I told you a story. It’s worth retelling today. I was Governor of Utah during the 2002 Winter Olympics. I told you about a 16-year-old figure skater named Sarah Hughes, who was in fourth place on the final night of the games. Nobody expected her to win.

The music started to play and she skated with a grace that captured a billion people around the world. The music stopped; her head went back; she had done exactly what she envisioned she could do. She was a 16-year-old girl, who the day before had been studying for the SAT exam. She won the gold medal.

The next day at a news conference, Sarah Hughes was asked how she felt. She said, “I’m mostly grateful. Some people never get the chance to skate the performance of their life, and I did.”

This is your chance…to skate the performance of your life. Don’t miss it.

Last revised: October 19, 2006