Marcus Welby, MD v. ER?

Gov. Blanco and Sen. Vitter have come to an agreement of the nature of the future of public health care in Louisiana.

Gov. Kathleen Blanco and U.S. Sen. David Vitter agreed Wednesday on a plan to give Louisiana State University $74 million to buy land and hire architects for a new teaching hospital in downtown New Orleans.

The announcement serves to restart a process that stalled unexpectedly last week when the state House of Representatives rejected a plan to direct $300 million in federal money to the hospital project. But it leaves unresolved the deep divisions between state and federal policymakers over the broader question of how to overhaul the state's health-care system.

Calling the hospital a "vital part of our state's recovery" from Hurricanes Katrina and Rita, Blanco said LSU will get another $226 million in federal Community Development Block Grant money after it completes a business plan detailing how the hospital would operate.

"This state-of-the-art teaching and research facility will play a significant role in our efforts to redesign Louisiana's health care system," Blanco said.

There are two basic issues at work here:

1. Funding buildings versus people - One camp in this debate wants to rebuild the old Charity Hospital and dispense health care to the poor at those facilities. The other camp proposes the entire health care system in Louisiana be revamped.

LSU officials said the question of whether to build a hospital should not be tied to the broader health care redesign.

"They are two separate debates," said LSU System President William Jenkins, who said a final decision on the hospital is needed soon to reduce the threat of physicians and researchers leaving the New Orleans area.

"There is growing angst among that group . . . about what the future holds," Jenkins said.

With Charity and University hospital decimated by flood damage, state officials set aside the $300 million in block-grant financing for a single replacement hospital last year. But there has been disagreement over how big the hospital should be and whether it can survive financially if health care spending is reshuffled.

2. Its the size that matters - Even once the configuration of the health care system has been determined, the size of the hospital still remains. The state can either construct a single, large general hospital, or it can go with a smaller hospital with several clinics scattered about the city to dispense health care services at locations closer to the customers.

Wednesday's agreement also does not address the size or scope of the proposed hospital, which has been of great concern to the private hospitals that would likely be competing for patients.

After saying for months that they had hoped to build a 350-bed hospital at a cost of about $650 million, university officials unveiled a preliminary business plan late last year that called for 417 beds at a cost of $950 million.

The Louisiana Hospital Association, the Metropolitan Hospital Council of New Orleans and the Public Affairs Research Council of Louisiana are among the groups arguing that the hospital doesn't need to be that large or expensive.

State Sen. Joe McPherson, D-Woodworth, who heads the Senate Health and Welfare Committee, said the size of the hospital should be decided by professional consultants, not politicians.

"I don't think a congressman or a legislator or an insurance salesman should be dictating what kind of new hospital should be built," McPherson said. "That's a job for experts in the design and engineering field on the advice of expert consultants."

McPherson predicted the Legislature will move forward with a new hospital regardless of whether the federal government agrees to provide the seed money.

"If they take the federal money off the table we'll still be building a new hospital," McPherson said.

At least there is a debate going on in this state about this matter. Unfortunately the discussion revolves around moving forward versus the status quo. That means there always a chance the status quo wins.