Tough decisions are needed for reform

Few if any favor reforming Medicaid more than I. The health program for the low income was expanded during the Carnahan years to include more Missouri residents than taxpayers can now afford. Recognizing the problem is the easy part - finding a solution is proving more difficult.

The Missouri legislature now wants to make unwed fathers share some of the medical expense when Medicaid mothers give birth to their children. That idea sounds wonderful on paper but it may be counter-productive to implement.

The problem is startling. Medicaid pays for 43 per cent of all births in Missouri to the tune of $120 million last year. Two-thirds of those Medicaid births were to unwed mothers.

A proposal is being discussed that would go after the fathers of these children for some of the expense in giving birth. When that option is possible, it's a great idea. The problem is deciding just who has the ability to pay some of the costs and who simply cannot. Finding that delicate balance will surely be difficult.

Studies in other states show that the collection concept often does not work. The bottom line is that many if not most of these unwed dads don't have the funds to help pay for the births. And as much as I'd like to say you shouldn't have children if you cannot afford them, that sad reality of life shows no signs of changing.

The issue gets back to the problem I have addressed for years - personal responsibility. Can you mandate responsibility? Thusfar, the answer is no.

Since when is anyone entitled to free health care? That seems to be the problem. When Gov. Carnahan and then Holden decided to swell the ranks of the Medicaid rolls, they did a substantial disservice to the residents of this state. Now we'll pay for that mistake by taking money from other essential programs.

We can't discuss limiting births based on financial responsibility and yet we can't afford the pricetag for that population. Sadly we are now in our second generation and will soon be in our third generation of those who ask for others to pay for the birth of their children. Just look at this newspaper and read the names of women having their third or fourth child while still single. And then recognize that it will take tough decisions and unpopular decisions to bring common sense and fairness back into the policies of this state.