Meanwhile, back in Louisiana…

Meanwhile back in Louisiana

Sunday’s paper brings news of “35% cuts to state budget on table.” Fantastic. Never has better news been reported, though the Advocate sounds sad. What to cut is of course the question. The answer is, of course, always fearful news for everyone, supposedly.

But so what cuts are made in higher education? Let those institutions shift to what people will pay to learn. I’m sure, given today’s news that “Future hiring to help skilled,” that people will pay some amount to learn something. And I’m sure they could pay a market rate for the service; they do for most everything else. I’ve said it before, if a professor wants to earn $100,000 a year let him set a fee, and a course of study, and attract the students that might make up the number. Why should anyone subsidize the learning? If the cost is $1,000 for the class, than that’s the cost. Make the cost the price. But right now the price is much lower, possibly therefore giving incentive to people who will not really be good in a certain profession to get an education in it. Ironically, if Law school was priced at the cost we might have less lawyers, and could anyone be upset with that?

People will still gravitate to those jobs which pay more, those that are capable, and willing to spend money to learn something, however, even if the price is the same as the cost, like nearly everything else. But by putting higher education in the budget then the cost is obscured and the price by the consumer of the education is much lower than it really would be, or could be supported in a free market. I’d bet there would be a lot less partying on campus if the price did not hide the cost. Why should some frat boy worry that this grades aren’t good enough, or he’s taking basket weaving so that he might just get a degree. And do we really need so many people in a university? Aren’t some professions, like plumbing, electrician, better learned in trade schools, and on the job training? Sure, “lawyers, doctors, research scientists, software engineers,” they’ll be needed. Great, so how much is someone willing to learn those skills? If it’s not much, or as much as a professor might want, then either that professor will earn less, or someone willing to earn less will be willing to do the job. There’s no shortage of professor grade quality people. So cut the higher education budget to Zero, get it out of the budget. Perhaps, just that alone would be enough to offset the coming budget shortfall.

But then the article on Budget Cuts has a second tag line — “Jindal insists it is better than taxing.” How true that is! And yet, somehow, linguistically, the headline sounds sad, like, man, why does he insist on something silly like that. Shouldn’t the second line, the sub-headline have said — “state is $2 billion short of funds”? Sure it should have. Because the state is. Where does anyone think that $2,000,000,000 is going to come from. When a family or business has a “budget shortfall” they don’t arbitrarily reach into their neighbor’s pocket to make up the shortfall – they cut spending. That’s the problem, too many in government think, well, the budget is set in stone for all time, unless bigger of course. It’s nice that Jindal insists taxes shouldn’t be raised, the paper shouldn’t lament.

For if taxes were raised by $2 billion and no cuts were done, then that would put Louisiana even further in the hole down the road. For taking $2 billion out of the economy, to keep the Universities as big as they ever were, is going to kill more jobs, it will shutter more businesses, it will lower sales of goods and services by $2 billion. Thus sales taxes for municipalities will go down – if $2 billion isn’t spent, and the rough sales tax is 10% (it’s actually 6 to 9 % depending on Parish, but it’s early in the morning, and I’ll do simple math, thank you,) then parishes and municipalities will lose $200,000,000 in sales tax revenues. So then next year’s budgets for those entities will be that much more stressed.

And true too, all the agencies always talk about the pain to the public if the budget is cut. You know, police, fire, children, elderly. But if the budget is cut by 35% there’s actually no reason to lower any specific cash for real services. Cut the administrators, cut the pensions, the fancy offices, the junkets, the paper clips in need be. Cut the seekers of federal grants, the “stimulus money” — how much does the compliance cost, with federal rules, or even state rules when a parish (those are our counties for those outside our mush pit,) gets money? How many administrators are really needed? I’d estimate, oh, about 35% less. Wow, not that’s cutting the budget right there, but um, 35%.

For instance, it’s talked about cutting hospitals for the poor. But does that mean you really have to get rid of nurses, technicians or doctors? Not at all. Costs could easily be cut by cutting administration. So what if a hospital has one less administrator – why is it that large corporations, and companies of small size too, get along with so much less “management,” so much less administration. And the private sector works until 60 or 65 years old, but the public sectors seems to be retiring at 50 or 55 years old. Why are they so special? Even a silly thing like the cost of paperwork – every time I go to a doctor I have to sign some privacy statement or some other form – do we really need all those forms in paper? If I can sign for my credit card purchase with an electronic reader, couldn’t that be done at the doctor’s office? And my doctor’s team is lean and mean, and even they could cut costs. How many forms are there for the “poor” — and who’s making money from them?

And if you’re providing health care to the poor – or to really, anyone who walks in – why doesn’t the state just set up the clinic or the hospital, pay the doctors and nurses their salaries – and eliminate the entire rest of the administration for eligibility, compliance, fair use practices, non-discrimination, purchasing agents to make sure low-bids are met or something, and budget reviewers and who knows what all? Why does the state hospital system have a huge bureaucracy making shore that no one gets more than their fair share? If the state wants to run a hospital system, which is actually, to me, a reasonable thing, then set it up with the minimum amount of costs, except for the front line people, and then just serve anyone who strolls on in. If a city, such as, say, Ferriday, up in the rural hinterland, has 20,000 people, then a front line clinic could surely be funded so that anyone walking in would get care – a general internist, the first line guy, is what? $100,000 a year? So pay him that.

Then whomever shows up gets cared for. If something is a bigger problem, then that person can be moved to a larger facility, also on the same basis – salary = provide service. I think it’s reasonable to put say, specialized cancer services in a more centralized location; it’s already done with private hospitals. But the state is so worried about verifying income eligibility for receiving the service that there’s two or three employees just making sure that no one who earns over some amount gets anything unless they pay for it some other way. The very costs of tracking down all that insurance stuff is pointless – provide the service, and don’t worry about “Ability to pay” — the state would already be paying the doctor. And too, except since the middle class and the rich pay for the hospital in taxes, why should they be forced to pay again because they “earn too much”?

To me, if the state sets up a hospital – and a middle class $60,000 a year plumber comes in – then serve him. Don’t make him jump through hoops, and don’t pay an administrator to set the hoops up. And if a poor person comes in – then serve her – don’t make her jump through hoops. In fact, if the state was providing hospitals like libraries or parks or roads, then it should make no difference how much money someone earns as to whether they should or should not get the government service. No one says to a victim of a robbery, oh you have to pay more for police service, because you’re above a certain income level. No one says that when the firemen come to your house they first see if you’re income eligibility for fire services is met or exceeded. No one questions the income levels of those who use libraries, state parks, and so forth. But for state provided medical care this income eligibility is somehow a necessity, leading to endless administration.

And that’s administration bucks. That’s the 35% that can be cut. I’m not sure Jindal sees this. Or if even the laws as constructed today allow what I would envision – a hospital like a park – use it regardless of your income status, or aggrieved minority status, your veteran or other status. And that should cut the state hospital budget by 35% and still provide medical services.

I’m well aware that it might not be a straight line between what is the system today and what I envision — the devil is in the details — but it’s the concept that must be pursued. The entire medical care debate was about how much government was needed to run it instead of about how many doctors and nurses were needed down at the clinic in places like Ferriday — and this is true on the national and the state levels — but if you want a state run hospital, provide that service like a park, and cut out the administrators. I’d guess there’s $2 billion in administration that could be cut from a $28 billion dollar budget and not put a dent in the provision of services of a real kind. There’s nothing real about a bureaucrat with a form, it’s all for naught, for appearances. No bureaucrat ever took someone’s blood pressure. But they sure have caused it to rise up precipitously with their famous line “Oh, I’m sorry, you don’t have the right form to do that.”

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