Senator Eliot Shapleigh - El Paso, Texas

(Laura Skelding/AMERICAN-STATESMAN) Lt. Gov. David Dewhurst outlined legislative priorities Thursday, including tuition and taxes.

While outlining a wide-ranging wish list for legislative action — including possible reductions in state spending, consideration of a further rollback of property taxes and tuition caps — Lt. Gov. David Dewhurst on Thursday also advocated a transformational change in Texas' health care system.

"We're not focusing on keeping people healthy — we're focusing on ... getting people well when they show up at the hospitals," Dewhurst said. "We're going to have to change how we practice medicine."

Warning as he has in past years that spiraling Medicaid costs are outpacing government spending for schools, public safety and other essential needs, Dewhurst said he would like to see the Legislature pay for a pilot program that stresses preventive care — instead of the current practice of paying doctors and hospitals for the numbers of medical procedures they perform.

He offered no specifics on the pilot program.

"I'm totally convinced that our model is unsustainable," he said, adding that doctors and hospitals should be well-paid. Even so, Dewhurst noted, health care spending now consumes a third of the state budget.

"I want to look at a transformational solution ... to get us into the end zone. ... We don't have health care in America. We have sick care."

Dewhurst said he also favors looking at caps on further college tuition hikes, despite his support in 2003 for letting universities set their own tuition rates. Facing a major state budget crunch in 2003, Dewhurst got behind a fiscal rescue package that triggered double-digit increases in tuition and fees at Texas universities.

"We just can't afford to price out deserving young people going to college," Dewhurst told reporters at a Capitol luncheon Thursday.

Dewhurst also talked about the state's troubled residential institutions for people with mental retardation, known as state schools, saying that they should stay open but that Texas may need to limit the number of people living in them.

The Senate's draft budget designates $200 million in state funds for a program that helps people with disabilities live at home or in group homes rather than in institutions. That funding would be contingent upon the Legislature passing a measure to cap the number of people in the state schools at 3,000.

Some advocates and lawmakers have suggested closing some of the state schools. A December report by the U.S. Department of Justice said the 13 facilities — which are home to about 5,000 Texans — fail to protect residents from harm.

"I'm not against state schools like the DOJ is," Dewhurst said.

On other issues, Dewhurst said he has asked Senate budget writers to look at state agencies' current spending to see where reductions might be possible in nonessential services in the likelihood that the budget might be even tighter in 2011.

"Every 1 percent (cut) saves $400 million," he said, quickly adding that, with the economic slump, "we don't need to be raising taxes on people."

At the same time, Dewhurst said, he will ask the Senate to consider passing measures that would reduce property taxes, expand the number of flagship universities and work toward cleaner energy sources — including wind, nuclear and solar power.

Dewhurst also promised to find the money to put low-income children on the rolls for the state-administered Children's Health Insurance Program if they sign up.

About 550,000 Texas children are enrolled in CHIP, but Dewhurst said thousands more who are currently eligible have not signed up.

And raising the issue that split the Senate in a bitter partisan fight last week, Dewhurst said the passage of a "fair voter ID bill is important." Without providing details, he said he remains confident that Republicans and Democrats can devise a bill that both sides can support.