HJNO Mar/Apr 2024

When I was a student at LSU, I remember sitting in a government class being asked, “Which is the strongest branch in U.S. government?” Hands popped up. “The executive branch,” one kid said smugly. “Wrong,” we were told. The next group of hands, “The legislative!”“Wrong,”the professor said. Well, we all knew there was just one more, but only one kid sheepishly put their hand up and asked, “The Judicial?” “Correct!” the professor said and went on to explain that all the others can make laws, rules, but the judiciary interprets them and can either uphold them or knock them down. That makes them the most powerful, we were told. It was a little mind-shifting at the time, and I never looked at our branches of government the same. This insight stayed with me, resurfacing recently amid the Blue Cross and Blue Shield of Louisiana/ Elevance on-again, off-again merger saga. In this healthcare drama, the players take on governmental roles: providers as the executive branch; hospital, drug, and equipment companies as the legislative; and insurance companies as the potent judiciary. In America, it is the insurance companies that rule where a patient can be seen, by whom, and, because payment is involved, what can be done to that patient if those providing the care want to be paid. We have spent a lot of time in this Journal questioning why Louisiana ranks last or near the bottom of nearly every health index. The truth is, it is currently more expensive for our citizens to be healthy than not, but unhealthy citizens cost the system more. We all know the system is broken that way. We all know the causes of most chronic diseases lie outside a physician’s office. You get sick patients downstream when they could eliminate these conditions upstream. Incentives to eat an organic diet, stress reduction methods like massage, adult exercise programs, ancient healing methods like acupuncture are not covered by most healthcare insurance companies but shouldbe absolutely coveredby a “health”insurance company. I humbly suggest we have a once-in-a-lifetime opportunity here to take the most powerful branch in healthcare and make it the most impactful branch in health. It would save money and lives. We could do it here in Louisiana first. BCBSLA, I beg you to experiment with this. I know the thought of this causes a quick inhale for providers, drug companies, hospitals, and yes, probably for BCBSLA. As Kenny Cole, MD, has pointed out issue after issue, we are perversely incentivized by the current system to have more patient encounters. I ask us all to dream a bit — to envision what a healthy community in Louisiana could look like. Just imagine a life where things we know eliminate a lot of disease are affordable for all: stress-relieving massage treatments, guided exercise for adults, fast food options that are healthy, and Louisiana chefs who create Cajun cuisine that is both delicious and heart healthy so we can enjoy it more! These community-wide changes would make us feel better, our home lives sweeter, road rage diminished, and chronic conditions lessened. We really could lead the nation with the right incentives. We all know this would save money and lives. BCBSLA could lead this; they may be the only ones. And as far as practitioners getting paid and having hospitals prepared when we need them, nobody wants to cut your paycheck. We want the brightest and smartest to continue to go into the field of healing arts. We all want great healthcare and are willing to pay for it; we would just like you less busy with diseases that can be stopped. There is an opportunity with this small state, with an insurance company in a unique financial standing, to do something revolutionary for their members. Dream, my friends. This is our time to make good leadership decisions; we can continue to be part of a broken system, or we can break out of the system. BCBSLA can drive it. Believe me, if we can make this happen, all eyes of the country will be on this state. We can lead the way. I hope we take advantage of this opportunity of a lifetime, EDITOR’S DESK Dianne Marie Normand Hartley Chief Editor editor@healthcarejournalno.com BCBSLA May Hold the Key to Fixing a Broken US Healthcare System— If We Are Courageous Enough to Try… HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2024 9