COLUMBIA--The architect for overhauling South
Carolina's Medicaid program is an associate finance professor at a Cleveland
State University think tank who says people want all the health insurance that
someone can afford to buy for them.
"Americans, regardless of their incomes, want the best health care that
someone else's money can buy," Michael Bond said in 2004 while testifying before
the Ohio Medicaid Reform Commission.
In a recent interview, Bond, a senior fellow in health care policy at the
Buckeye Institute in Ohio, said South Carolina's big problem is "there's no
control on usage. You have a group of people who see no costs."
Gov. Mark Sanford has taken that to heart.
"There's always an unlimited demand for a product somebody else is paying
for," Sanford told the nation's governors earlier this year at a meeting in
Washington. "If you believe in the future of our country, you've got to look to
the big three -- Medicare, Social Security, Medicaid -- entitlement spending."
Sanford now is seeking federal approval to make South Carolina's Medicaid
program the first in the nation to require Medicaid recipients to buy health
insurance and pay premiums with government-provided money or make co-payments
for medical services for children who live in poverty.
Bond and Sanford met last year through the Washington-based Heritage
Foundation, a conservative, nonpartisan think tank familiar with Bond's
philosophical opposition to state-sponsored medical care.
Medicaid's state and federal dollars provide basic health care coverage for
about 850,000 South Carolinians, including about half the births in the state
and three of four nursing home residents.
For years, the program's rapid growth and size have prompted calls to make
Medicaid more efficient in South Carolina and elsewhere. In 1995, about 10
percent of the state's general fund budget went to Medicaid. In the fiscal year
that ended June 30, it had jumped to 19 percent. Without changes, the forecasts
show Medicaid will consume 29 percent of the budget within a decade.
South Carolina and Florida now want federal approval for Medicaid overhauls
based on Bond's economic models that some hail as bold and others as risky.
Critics say Sanford's plan is based on several unproven premises, including
that private insurers can deliver medical care more efficiently than Medicaid.
For instance, they note the cost of private insurance is up 41 percent in the
past three years, well above Medicaid's 27 percent during the same time.
They also say there's a flawed premise that Medicaid recipients overuse
medical services because they don't have to pay for them.
For instance, Robbie Kerr, Sanford's director of the Department of Health and
Human Services, frequently points out that just 5 percent of the state's
Medicaid patients account for 55 percent of Medicaid's cost.
Those chronically ill people "are disabled and have long-term, high-cost
needs," said Sue Berkowitz, director of the South Carolina Appleseed Legal
Justice Center and critic of the overhaul proposal.
While Medicaid is considered a safety net for the health care needs of the
poor, disabled and elderly, the plan proposes a cap on what the state can spend
on indigent care, regardless of rising costs or more people needing help.
