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In the late 1980s, some epidemiologists feared the indomitable AIDS epidemic might obliterate entire civilizations; now the killer can often be controlled with a pharmaceutical “cocktail.”

The mystery of DNA has not only been unraveled, but is now employed as an oracle to predict the future onset of diabetes, cancer, obesity and other medical problems and as a guardian to repair and protect cells from defects and damage.

Clot-busting drugs now even the odds of surviving once-fatal heart attack and stroke—the nation’s leading causes of death.

Remarkably, most cutting-edge technology, medication and procedures are now available in Baton Rouge—not only at the traditional general hospitals but in new sleek, surgical specialty hospitals as well.

Two years ago, the city’s medical community suddenly became de facto first responders and triage coordinators for the entire state of evacuees, who first fled northwest from Katrina and northeast from Rita.

“We learned we could absorb a tremendous amount of volume in a quick time and handle that,” says William R. Holman, president and CEO of Baton Rouge General Medical Center.

Since then, Baton Rouge has matured into South Louisiana’s largest, most stable and sophisticated medical center.

Despite developments in medical science and the community’s new status as a major medical center, the lack of accessibility, coordinated care and compensation for services have prevented Louisianans—and Americans in general—from receiving exceptional, sometimes even adequate, medical care.

“I marvel at changes in discoveries and applaud achievements in technology,” says Robert C. Davidge of Our Lady of the Lake Regional Medical Center, the only hospital CEO who has both witnessed and influenced local health care over the last quarter century.

“It’s what hasn’t changed that concerns me: Earl K. Long [Medical Center], in 1980, was the next scheduled replacement hospital. It still is. We still have indigents and more of them, but we haven’t done much to change their care. Louisiana is still 49th or 50th in the health care ratings,” he says.

Even though Louisiana’s charity hospital system stagnated, public and nonprofit organizations brought some relief. Since the late 1990s, the Greater Baton Rouge Community Clinic, St. Vincent DePaul Community Pharmacy and Louisiana Children’s Health Insurance Program have provided medical and dental care and low-cost prescriptions to the working poor.

The indigent are not the only population disenfranchised by the health care system.

“Every eight seconds a new person is reaching Medicare age,” explains Bill Borne, CEO and founder of Amedisys Home Health Services. “The health care system can’t afford it; 17% of the GDP is now spent on health care. We’re not prepared to care for what we’ve got, and the race just started.”

In fact, Borne is plotting a coup. “We are at the epicenter of a health care revolution to manage the chronic co-morbid population,” he declares.

The instigator of the insurrection is—basically—grandma, (or grandpa, if he lives long enough). As a 75-year-old with four diagnoses and nine medical specialists, this typical “co-morbid” patient is a high-acuity and high-frequency health care consumer and part of the 33% of the Medicare recipients spending 66% of the dollars.

Borne insists home health care is poised to lower the cost of health care delivery for chronic patients, add value to the patient’s life and simplify care for specialists.

Its employees can go into the patient’s home, collect data on routines, refrigerator contents, exercise habits, self-care abilities and fall probability, among others.

Based on the patient’s unique situation and information recorded in a comprehensive chart, the home health professional can work with the physicians, patient and family members to coordinate care, encourage medical compliance and lifestyle changes and improve quality of life.

While coordination of the care may become the biggest challenge for aging baby boomers, Davidge maintains three forces shape today’s health care environment.

“Those issues are cost, technology and expectations. Everything else is a subset,” he says.

Colorful CAT scans, argon-beam coagulators and robotic surgical assistants perform their magic in diagnostic centers and operating rooms, but Holman cites an unheralded advance that remains invisible but invaluable to the care of every hospital patient.

“Twenty-five years ago, we didn’t have the information technology—electronic medical records. We still have issues and challenges in front of us, but now, the patient is much safer.”

Technology definitely saves lives. It has also engendered an inequity of cost and outcome. For example, a three- to five-day hospital stay was typical for an open-colecystectomy; now, laparoscopic patients who have their gall bladders removed laparoscopically may be discharged the same day.

So, while the payer’s cost decreases, Davidge says, “the operating costs have increased with additional staff plus equipment; yet, society has benefited from returning that individual home. It is a mismatch of cost and return.”

Because both the indigent and elderly population are the most voracious health care consumers, one of the largest payers is the federal government through Medicaid and Medicare programs.

“Government is paying for one-half of inpatient care provided nationally, and the government doesn’t cover the cost,” says Teri G. Fontenot, president and CEO of Woman’s Hospital. “The shortfall is passed along to commercially insured patients or employers.”

In 1985, local employers reported buckling under annual health insurance rate hike of 25%. Since 2000, employers’ health insurance costs have increased 100%. The result is the growth of consumer-driven, high-deductible plans from 2% to 38%.

“The larger deductible is showing up as bad debt (for providers),” Davidge says.

The fallout has hospitals struggling to meet expenses and doctors.

“Ob/gyns in Louisiana have not gotten a rate increase since 1990s; malpractice has tripled, then there are staff and offices costs,” Fontenot says.

Nonetheless, hospital surveys continually demonstrate patients expect more than just five-star hotel service.

“There is the expectation for perfect results,“ Davidge says. “We expect to live forever. We expect mama to live forever. We expect doctors can perform miracles. We enjoy our excesses—drugs, smoking, obesity, driving without a seat belt—and expect they will not impact us as individuals.”

And still, the medical community continues to invest in Baton Rouge—expanding its missions, services, campuses and alliances with nationally renowned centers of excellence.

“In the next 25 years, I’d like to see the state of Louisiana at the top of the good lists and the bottom of the bad lists,” Fontenot says. “I would like to see us known for high-quality health care in Baton Rouge and excellent outcomes.”

She cautions, however, even high-quality medical care can’t guarantee a healthy population. “There’s a patient responsibility component, too.”