Bluegrass Beacon - Medicaid reform: Compassionate or cruel?

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An example of how the British government in the 19th century used the magic of incentives to improve survival rates of prisoners transported on ships to Australia could offer clues about how to right Kentucky’s listing Medicaid program.

For years, barely half the Australian-bound prisoners survived these voyages.

Despite ardent appeals from church, humanitarian and government leaders imploring ship captains to improve conditions, survival rates failed to change.

Finally, social reformer Edwin Chadwick recommended offering different incentives by adjusting how ship captains were compensated.

Chadwick suggested that instead of paying captains a fee for each prisoner who walked onto their ships in England, they would be paid only for prisoners who walked off ships in Australia.

Changing the incentives for captains immediately and dramatically improved survival rates to more than 98 percent.

Captains now protected prisoners’ health and well-being by providing them with better food and hygiene during their passage, as well as reducing the number of inmates crowded into each ship.

Incentives achieved what even appeals from the clergy failed to accomplish.

The right kind of inducements also can bring about some dramatic improvements in Kentucky’s health-insurance policy.

Adding hundreds of thousands of Kentuckians to Medicaid by expanding eligibility resulted in dangerously overcrowding the commonwealth’s Obamacare ship.

Close to 30 percent of Kentucky’s entire population is now crammed into this tilting vessel.

Supporters of the government-run plan brag about and receive nationwide acclaim for building such a beautiful, shiny sparkling ship.

Yet stroll through the lower decks and you will find an overloaded vessel with humiliating conditions from which too many enrollees may never exit – unless incentives are changed.

Plus, as degrading as the conditions on those British ships were, the captains always knew their destination.

However, a major point of confusion concerning Kentucky’s Obamacare ship is its true terminus.

Not everyone agrees that the anchor of government dependency should be lifted, allowing this ship to sail into a harbor filled with opportunities for able-bodied adult Kentuckians to find decent jobs and earn a good living in order to achieve the kind of lifestyle that allows them to purchase their own health-insurance plans and receive care from doctors they choose.

Opponents of Gov. Matt Bevin’s Kentucky HEALTH plan – which seeks to improve the chances of most of the recent Medicaid enrollees reaching a destination of dignity by paying a small premium, getting treatment for an addiction, training for a job or volunteering in their community – seem wholly uninterested in allowing anyone off the ship.

They go to great lengths to avoid confronting their antagonism toward teaching fellow Kentuckians to fish instead of keeping them dependent on government fish.

They also often attempt to change the conversation altogether by focusing on groups that will experience little, if any, change should Washington approve the Bevin administration’s proposed reforms.

Absolutely nothing in Bevin’s plan would, for example, change benefits for children, pregnant women, the disabled or poor.

Still, a letter writer in western Kentucky thinks I’m “mean-spirited” and “lacking compassion” because I support incentives designed to get prisoners off the ship, out of a defeated and miserable lifestyle into a victorious, productive life.

How compassionate is it to adamantly oppose incentives that will keep Kentucky’s Medicaid ship from sinking by sailing into the harbor and unloading able-bodied adults crammed onto its decks, giving them the opportunity to move into a place where they can contribute greatly to our society and maybe even help others?

If the Obama administration wants to show true compassion, it not only will approve the Bevin administration’s waiver request to implement the HEALTH plan’s thoughtful and reasonable incentives, it will do so immediately and enthusiastically.

Jim Waters is president of the Bluegrass Institute; Kentucky’s free-market think tank. Reach him at jwaters@freedomkentucky.com. Read previously published columns at www.bipps.org.