Medicaid is the major thread of our state’s safety net. Katrina’s aftermath clearly shows how vital this safety net is — and the catastrophic results when it fails. Many people in New Orleans died after Katrina because they were sick with chronic conditions. Many died because they went for days (maybe a week or more) without their maintenance medications, then were dehydrated and hungry.

Katrina struck New Orleans at the end of the month and shut down the safety net before people could get their benefit checks (disability, VA, Social Security or retirement) due at the beginning of September. It shut down the safety net before patients could get their vital prescriptions refilled. (Most private and governmental programs will only refill every 30 days — at the beginning of each month.)

Under the best of circumstances, getting prescriptions refilled for people who rely on the safety net is arduous. So diabetics went without their oral medicine or insulin, which needs refrigeration. Asthmatics went without their medicine and breathing treatments, which require electricity. Patients with congestive heart failure went without the drug regimen that maintains their heart functions because flooding closed their drugstores.

Katrina drove home the idea that government policies (or the lack of) have real consequences for peoples’ lives. Being chronically ill makes people more vulnerable. The slightest disruption can easily upset their tenuous hold on life. For many in South Carolina, Medicaid means the difference between living a productive life or dying.

The Sanford administration’s Medicaid reform proposal will have real consequences for South Carolinians. It will make South Carolina’s weak safety net weaker. The ultimate irony is that the proposed Medicaid changes won’t really save any money.

The Medicaid recipients covered by the Sanford administration’s Medicaid reform proposal, at least as reviewed in the publicly available version, are those who are the “better off.” Recipients who use the program relatively little — they are the least costly patients. The most costly Medicaid patients are the disabled (including those with mental illness) and long-term care patients — the frail elderly. These high-cost patients are not part of the Medicaid reform proposal.

It’s the old 80-20 rule; the greatest number of Medicaid recipients actually cost, on a per capita basis, the fewest dollars. So restricting their demand for health care services, through requiring co-payments or other “consumer-driven” options, in reality isn’t likely to save many Medicaid dollars. It will make Medicaid more expensive to administer and more costly for providers (physicians and hospitals) to manage. This only further discourages providers, especially physicians, from participating in Medicaid.

Medicaid’s bite on South Carolina’s fiscal resources is increasing proportionately because health care services are expensive. Medicaid’s increases aren’t out of proportion to the increases seen in the South Carolina State Employees Health Insurance Plan, or in workers compensation, or employer-sponsored health plans in the private sector. Health care inflation annually increases 2.5 percent more than the economy’s overall rate of inflation.

Resolving Medicaid cost issues will require more than the Band-Aid reform proposal from the Sanford administration. It will require the reform of our entire health care financing mechanism and restructuring our delivery “systems.” Anything less is just a waste of time and resources.

Sanford’s reform proposal will increase the number of uninsured in South Carolina. It puts in place incentives for patients to avoid appropriate medical services until a catastrophic health care event occurs and an individual’s private catastrophic plan can kick in — assuming the private health insurance market will even have this type of insurance available for this population. Hospitals and physicians will face increasing contractual and bad-debt write-offs. This will force providers to increase their charges where they can, for the privately insured and the uninsured. It will make our safety net weaker.

As the ad hoc committee reviews Sanford’s Medicaid reform proposal and waiver request, it is important for members to remember that, for the most vulnerable South Carolinians, it doesn’t take much to tip them over the edge — a hurricane at the end of the month might be all the disruption needed. They also need to remember that changes in Medicaid will ripple and multiply through all levels of South Carolina’s health care economy and affect even the well-to-do and the insured.

Yes, Medicaid needs reform. It needs to be better and more efficient. Most of these program changes don’t require a waiver. A waiver isn’t needed to fund and use a good information system to manage care.

The current proposal won’t make Medicaid better, and it will make real people’s lives harder. Trying to fix our health care cost problems on the backs of our most vulnerable citizens seems needlessly cruel, as the haunting images of Katrina’s aftermath remind me.

Ms. Bailey is a consulting health care economist based in Columbia.