By John David Dyche
Agriculture Commissioner James Comer, one of four Republican candidates for governor, is issuing a policy platform in installments. He calls it the "Comer-McDaniel Plan for All Kentuckians."
The first installment released recently is a "plan for a healthier Kentucky." Four more are to follow on higher education, government accountability, growing the middle class, and investing in Kentucky's future.
It is interesting that Comer chose to start with healthcare. Matt Bevin and Hal Heiner, his chief rivals in the close GOP nominating contest, both made job creation their top priority.
On the one hand, Comer's healthcare document is by far the best and most detailed platform in the race to date. Whereas his foes mostly settled for generalities, Comer offers background facts, contextual discussion, philosophical frameworks, and several specific proposals.
On the other hand, however, Comer is arriving late at the platform party and has not brought all his presents. He has been running for months, the primary election is only about a month-and-a-half away, and he is only now releasing only a partial platform.
In fairness, however, Comer's document does list some major ideas soon to come in the other areas. It does so only in bullet-points, but that is practically as much as the other platforms provide, and at least he promises more.
Until then Comer is to be congratulated. His healthcare plan reflects real knowledge of the challenges confronting Kentucky in this field and represents an effort to address them honestly in a businesslike manner with "action items."
Comer begins with an important truth too often overlooked when politicians talk about Kentucky's abysmal overall health situation. The "low average household income of Kentuckians" is "a significant contributing factor" to our state's poor health.
He pledges to "create more jobs to increase median household incomes in Kentucky, thus decreasing the need for families to be on Medicaid, and making Kentucky less of a 'welfare state.'"
Comer next promises to "save and support Kentucky's rural health system," even citing a recent report by Democratic state Auditor Adam Edelen on rural hospitals. Democratic Governor Steve Beshear criticized Edelen's report for using outdated pre-Obamacare data and omitting some hospitals.
Among the admirable specifics in Comer's plan are pledges to "promptly and seriously consider whether to split the current Cabinet for Health and Family Services into two departments" and "to oversee the huge Medicaid program" and another one for all else, and to appoint a commissioner from "the provider community."
But there is an internal contradiction in Comer's claim to "be pro free-market competition and anti-regulation" while at the same time promising to support retaining the certificate of need program many consider to be anti-competitive and pro-regulation. Comer vows "a level playing field" within that regime, which some market participants see as being subject to political manipulation now.
The main thrust and most important part of Comer's healthcare package may be its Medicaid reform proposals. That inefficiently administered and extremely expensive entitlement, which Beshear recently expanded under Obamacare, is voraciously devouring resources the state needs for other purposes. It produces relatively poor health outcomes in the process.
Comer promises a massive overhaul. Among its elements are improving the payment process for providers, rewarding value instead of volume, and more regularly reviewing eligibility.
Some hostile media outlets employed huge headlines and emotive words like "KILL" to describe Comer's attitude toward Obamacare and the "kynect" health exchange that enjoys sacred status among the state's liberals. At the rollout of his plan Comer indeed emphasized his desire to move many Kentuckians from Medicaid to private insurance.
Critics are correct that Comer's policies would not necessarily provide a seamless transition and could leave a lot of Kentuckians who gained coverage under expanded Medicaid without it. But Comer's emphasis on unsustainable costs is understandable, especially since the state will have to bear part of the additional expense now paid for from federal funds.
Comer supports medical review panels "to identify and eliminate meritless cases and encourage early settlement of valid cases without going through the court process." This will not happen while Democratic Speaker Greg Stumbo, who is associated with a big personal injury law firm, controls the state House of Representatives.
The Comer plan also addresses topics like the healthcare workforce, long term care, and mental health. It may not be perfect, but on the whole it is an admirable and respectable effort of the sort voters deserve and should expect.
This columnist looks forward to the rest of the Comer agenda. And the sooner the better.
John David Dyche is a Louisville attorney and a political commentator for WDRB.com. His e-mail is firstname.lastname@example.org. Follow him on Twitter @jddyche.