Medicaid overhaul: Simplistic solutions will be ineffectual

Recently the Southeast Missourian published a column by James W. Wente, president and CEO of Southeast Missouri Hospital, regarding Medicaid facts. Mr. Wente called for a public debate on this important but expensive entitlement program. I agree wholeheartedly on that need.

Mr. Wente refers to Missouri as a national model because of the large segment of its population enrolled in the Medicaid program and lauds the fact that only 14 states have a higher percentage "insured." This is due substantially to lowering thresholds for enrollment which took place during the Carnahan administration. Simultaneously Missouri endured its greatest tax increase in state history.

Mr. Wente has a long history of respected experience in the delivery of health care in this region, and his opinion is to be valued. My experience as a surgeon and an executive involved in health care-related enterprises is also nontrivial. It is my view that the public should weigh the arguments on their merits and not necessarily accept them on the basis of their expositor. It is also my hope that others will join in the debate.

In the short term, it is my view that the problems of excessive enrollment and waste, fraud and abuse need to be addressed. The floodgates of enrollment were opened in the 1990s, and the threshold should be restored to the 1995 level in dollars adjusted for inflation.

Also there needs to be careful evaluation of those applying even at the lower threshold, as there is precious little verification of qualifications now. Ways to manage waste, fraud and abuse are legion and are beyond the scope of this letter to delineate, but little is being done to investigate and enforce current violations. I agree with Mr. Wente that the federal "clawback" provision should be either withdrawn or reimbursed from Washington.

I also reject Mr. Wente's notion that the state should assume an even greater role with regard to long-term care costs of those enrolled in Medicare and Medicaid. In my view what has been proposed will change the Show Me State to the Welfare State.

I am not indifferent to the plight of the elderly, and I feel the current level of support not just pays lip service to their needs, but in many ways fulfills them.

With regard to long-term solutions, I believe that nothing short of a systemwide re-evaluation and restructuring will do. Other states such as Florida are in the process of fundamental reform because the present system is unsustainable. Obviously a one-size-fits-all plan is not realistic, but we certainly can learn from their examples and, to a large extent, avoid reinventing the wheel. There must also be a concerted effort at growing the economy because as incomes rise so do tax revenues.

Lastly, I believe we as Missourians must decide if we want to live in a society which promotes and celebrates independence and personal responsibility. And we must decide how much of our income the government is allowed to take. Unfortunately there will always be more need than resources. Rather than appealing to Gov. Matt Blunt for help, I implore the citizens of Missouri to be not seduced by the siren call of entitlements. Instead, let us glory in the pride of achievement that flourishes in an atmosphere of independence. For every time we avail ourselves of government giveaways and expensive programs, we install one more bar in an economic prison of our own making.

Dr. Gregory A. Tobin of Cape Girardeau is a plastic and hand surgeon with Midwest Physicians and Surgeons.