The Storm-Calmer
From the Oct. 31, 2011, issue of NR.


Jim Geraghty

As a budget-cutter, Jindal puts most other Republican governors to shame, and has made choices that would spur Democratic apoplexy in other states. During his term, Louisiana’s state budget has become $9 billion smaller than when he started, a reduction of 26 percent.

We know what happens on those rare occasions when GOP governors successfully cut a state’s spending: The opposition spotlights hardworking, decent government employees suddenly laid off and denounces the draconian cuts. While the four no-name Democrats have tried to play that card in the current gubernatorial race, they have had no success.

It’s tempting to believe that the pre-Jindal Louisiana state government was so astoundingly wasteful and corrupt that you could cut spending 26 percent without anyone’s noticing, but a big chunk of Louisiana’s savings actually have come from privatization: The state pays a smaller fee to an outside contractor, who, in many cases, offers to hire the old workers, preventing tales of woe from laid-off employees. Jindal’s administration privatized the state’s Office of Risk Management. The Department of Health and Hospitals privatized six in-patient residential-treatment programs around the state, saving $2.5 million. Separately, patients were moved from state-operated institutions that cost $600 or more per patient per day to community-based services and private group homes that average $191 per day, saving another $23.8 million.

But some of Jindal’s cuts are the old-fashioned kind. The state’s Department of Revenue shrank from eight offices statewide to three. There are 9,900 fewer state-government employees than there were four years ago, and the state sold 1,300 vehicles from its fleet of automobiles.

Louisiana’s transportation department shut down a ferry that was used by only 7,200 drivers per year, saving the state roughly three-quarters of a million dollars.

In May 2011, Standard & Poor’s raised Louisiana’s credit rating from AA-minus to AA, citing reduced spending. The upgrade gave the state its first AA rating from S&P since 1984, and its sixth credit-rating upgrade among all three major credit-rating agencies since 2008.

Jindal’s careful budget management is reflected in his handling of health care, a complicated topic that vexes many Republican governors. Louisiana’s health-care system dates back to the 18th century, when Catholic religious orders established a tradition of free hospital-based care. Huey Long expanded that through the state-operated charity hospitals; today there are ten. The system predates Medicaid and Medicare, and any Louisianan can walk in and get free health care — if he or she is willing to endure the long wait times.

This model is well represented by Earl K. Long Hospital in Baton Rouge, a run-down monstrosity of a facility that evokes the worst aspects of Soviet architecture. Built in the 1960s, it barely meets reaccreditation standards and was given several extensions and exemptions after Katrina. “Even apart from a dollar perspective, it wasn’t really good for the patients,” Jindal says. “For folks with chronic conditions — diabetes, asthma, high blood pressure — going to an emergency room wasn’t the best way to get your health care. At Earl K. Long, 63 percent of the emergency-room visits are for non-emergency care.”

Replacing Long would have cost the state $400 million; instead the state expanded a nearby urgent-care clinic, and is building on a model used in New Orleans after Katrina, opening and sustaining outpatient clinics that charge patients on an income-based sliding scale, aiming to provide affordable care. (Jindal cites studies that indicate patients are more likely to follow a doctor’s instructions and keep appointments when they pay any portion of the fee, even as little as $1.) Just down the road, the state’s second-largest hospital, the private Our Lady of the Lake, is completing a partnership with Louisiana State University that Jindal’s administration helped shepherd, creating a Level 1 trauma center with a new emergency room the size of two football fields and a nine-story building dedicated to heart and vascular treatment. LSU residents will train at Our Lady of the Lake instead of Earl K. Long. Instead of the $400 million that would have been needed to replace Long, the state is spending $14 million.