Gov. Bobby Jindal's proposed changes for Louisiana Medicaid--Louisiana Health First--are now up for discussion, as details come out.

The former health chief says that the existing system works just fine, thank you very much--just tweak it. (On the other hand, would you expect a former administrator to say "I ran a bad program?")

According to the Baton Rouge Advocate, CommunityCARE (the old program) and Jindal's program (if enacted) both use "medical homes." The sticking point is whether government bureaucracies or private companies should be involved: "The Jindal administration insists that the private firms would provide the oversight needed to hold physicians, hospitals and other providers more accountable for the type of care delivered and at what price." Opponents of the idea argue, in effect, that for-profit companies are morally bad, a theme often heard in health care debates.

Another issue of contention is the use of one-time money: it is a useful tool for getting a new approach in place, or does it set the state up for trouble down the road?

The description of the program from this news account makes me think that the program is better than I had first anticipated:

If approved by state legislators and the federal government, Jindal's plan would set up managed-care pilot programs in New Orleans, Baton Rouge, Lake Charles and Shreveport. Most Medicaid recipients would work with state-approved counselors to choose between two or more private health plans, while those who don't make a choice would be automatically enrolled in a care network.

Rather than a fee-for-service model, insurers would be paid a flat monthly fee per enrollee, which would vary based on the health of the patient. The plans would then negotiate fees with doctors, hospitals and other participants in the network and work to ensure that patient care is coordinated among those providers.

For more on the proposal, see the web site of the Louisiana Department of Health and Hospitals. A fact sheet (PDF) from the department points out that the current spending pattern is not sustainable.