BANGOR, Maine — The idea that preventative measures and wellness incentives can lead to lower health care costs is not difficult to grasp.
Putting those things into practice is harder. Most people know they should eat well and exercise, for instance, but many find reasons to do otherwise.
As Steve Michaud, president of the Maine Hospital Association, explained this dynamic Wednesday to a roomful of Bangor area business leaders, most had just finished eating bacon, sausage, eggs and home fries for breakfast.
The message was clear: Changing habits is hard for everyone, but it’s essential to fixing the nation’s health care problems.
While lawmakers in Augusta spent Wednesday hearing from Mainers about deep cuts proposed for the state’s Medicaid system, Michaud and two other Maine health care experts discussed the broader problem of rising health care costs.
Gordon Smith of the Maine Medical Association and Bill Whitmore, representing Maine’s largest private insurer, Anthem Blue Cross and Blue Shield, also participated in the breakfast event hosted by the Bangor Region Chamber of Commerce.
All three agreed that the nation’s health care system remains fractured despite repeated attempts at reform but they also said the solution is multifaceted and still far off.
If nothing else, though, Whitmore said the health care debate at the state and federal level has forced more dialogue and more collaboration among the groups that have a stake.
Wednesday’s discussion centered on health care costs and how the continual increases have put a squeeze on businesses, but the discussion inevitably turned to the debate in Augusta.
Smith said the $220 million in Medicaid cuts that have been proposed by Gov. Paul LePage for 2012 and 2013 likely could further drive up private sector insurance costs.
As a representative for Maine’s doctors, Smith said he knows no physician who would refuse care to those who truly need it. But that care isn’t free. If the state or federal government doesn’t pick up some of the tab, others will have to, he said.
Michaud agreed that the proposed Medicaid cuts could have a dramatic effect, but he also conceded that the public health care system is in a world of trouble.
“We begged in 2004 not to expand the [Medicaid] program,” he said, adding that hospitals ultimately will end up shouldering the cost, at least in the short term.
Michaud said he supported structural changes to MaineCare, the state’s version of Medicaid.
Others in Augusta have criticized the LePage administration for asking for such drastic cuts in DHHS without considering other departments. The governor and DHHS Commissioner Mary Mayhew have been steadfast that the cuts are part of a long-overdue structural overhaul of the system.
The three Maine health care experts talked briefly about the proposed MaineCare cuts but they also addressed the impact of LD 1333, the state health insurance reform bill that passed earlier year, and the federal Affordable Care Act that passed last year.
Smith said, from a doctor’s perspective, coverage for patients is the biggest priority, which is why the Maine Medical Association has supported the individual mandate included in the Affordable Care Act.
“You can’t lower costs until you get everyone insured,” he said.
The individual mandate contained in the Affordable Care Act has been challenged by state attorneys general as unconstitutional. That issue likely will be settled by the U.S. Supreme Court.
According to Michaud, health insurance costs are only a part of the picture when talking about the overall cost of health care. For most insurance carriers, he explained, 20 percent of patients account for 80 percent of the costs. The best way to address that disparity is through preventative care, an element that often is lost in the health care debate.
It was Bangor doctor and City Councilor Geoff Gratwick who then joked about the irony of talking about preventative health care while the roomful of business leaders ate sausage, bacon and eggs.
Michaud said the best way to get people to truly change people’s habits is through their wallets. Companies that offer wellness incentives and disincentives have been successful in driving down costs.
No matter what happens in Augusta this week and in the weeks ahead, Maine businesses will still be grappling with how to rein in insurance costs.
“It takes a lot of work just to lower the rate of increase,” Michaud said. “No one is talking about decreasing costs.”