For more than a month, the Legislature has been focused on the governor’s proposal to cut $221 million from the Department of Health and Human Services budget by revoking Medicaid eligibility for about 65,000 low-income and disabled Mainers. His proposal has generated controversy, including marathon hearings, state house rallies, articles in many of Maine’s papers as well as a petition that garnered more than 8,000 signatures in less than two weeks, all opposing the cuts.
I hope our legislators are enjoying this exercise in democracy because, even if they are able to satisfactorily resolve the immediate crisis, they can look forward to a repeat performance in a year or two unless they have the courage, wisdom and bipartisanship to attack the fundamental flaws in the ways we finance and deliver health care services. Maine’s very real problems with MaineCare are only symptoms of defects in our overall health care system. The most visible signs are out-of-control costs and diminishing access to quality health care.
For the past few decades, insurance companies have been systematically pushing the least healthy off their rolls. As a result, many people have been forced to turn to public programs such as Medicaid, swelling its roles, or to their own inadequate resources. Predictably, the amount of uncompensated care facing hospitals and other providers is growing. The Maine Hospital Association recently sounded the alarm, warning that layoffs and further reductions in service would result from the proposed MaineCare cutbacks.
Attempts in the past to slow this trend by tinkering with the existing employment-based system have not succeeded. Our health care system does not need a tune-up. It needs an overhaul. And it must begin with the way we finance health care.
As the MaineCare hearings are demonstrating, our current fragmented system of financing health care breeds conflict. We have separate financing systems for different groups. Each constituency is focused on protecting its own program, often without regard to the effect on others. Each may believe they are being asked unfairly to shoulder somebody else’s burden. The result is stalemate.
That is one reason to move from our fragmented financing system to a single publicly managed pool in which everyone would participate. All would play by the same rules and eligibility issues would be moot. Questions of fairness among groups of people would largely disappear and our health care version of class warfare would be eliminated. Such a program’s universal base of beneficiaries would protect the plan’s popularity, funding and political viability. Care that exceeds the program’s benefits could be purchased privately.
In addition to simplifying administrative costs, this program could ratchet down out-of-control prices and windfall incomes and profits by individuals and corporations. Centralizing health care data would make it much easier to detect fraud, waste and abuse.
More than enough money to cover everybody would be freed up. It is credibly estimated that such a program could result in saving the people of Maine more than $1 billion dollars in the first year alone, and all but eliminate the pain and suffering created by fighting arbitrary insurance company denials. These changes would accelerate reforms in the way we pay purveyors of medical goods and services. That would permanently reduce the rate of future inflation of health care costs.
Some believe Americans will not give up choice of insurance plans. In my experience, people want a choice of health care providers but don’t much care who finances their care. Medicare, run by the much-maligned federal government, is very popular.
Maybe it’s time to have a serious public discussion about health care reform in Maine. It could start with updating the 2002 study of the feasibility of a single-payer health plan for Maine. That study concluded such a plan would be feasible.
Such a study could be privately funded and not have to wait for legislative approval. There are many public-service-oriented organizations in Maine that have the resources to take on the task. They are already pursuing useful projects, and I believe many of them privately understand the need for the type of changes I am recommending. But thus far they have been reluctant to actively advance the kind of systemic overhaul I recommend.
Maybe it’s time for them to step up to the plate and take notice of the elephant in the room. If we don’t undertake bold reform of our health care system soon, the legislature and the people of Maine are in for more tragic infighting. The losers will be all of us.
Well said. I am in a public system. I can go to any state in the country and find a government health center, where they swipe my card and my entire medical record is in front of my attending physician in seconds. I don’t get my health care for free – I pay co-pays on visits and prescriptions – usually its around $200 – $300 per month and last year when I was hospitalized for a very bad infection, I had the best pulmonary team in the country as far as I could see. No I don’t get to choose my doctors but I have never had a bad one. I am a veteran.
In agreeing with the article, I have been surprised that the single payer proposal has not been pitched to conservatives, moderates and liberals as a business-like, fiscally responsible method of financing health care, which it is. The second point is that if the discussions about reforming health care distinguished between the method of financing health care and who manages that method, the single payer method would have been easier to explain and sell across the political spectrum. Once the method is settled, then debate who manages – a public or private company, commission or other entity – and put all options for management on the table to evaluate. Third, the phrase “single payer” has been so demonized and reduced to mean an ideological argument about government-run health care versus insurance company run health care, that proponents need to come up with another phrase free of the ideological baggage.
In 1979 my proposal was for a single payer. Take all the money in the health care system and use half the money for a high deductible for everyone pro-rated for income – Bill gates, Mitt Romney, etc would have a million dollar deductible. Most of us would have a $5,000 – $10,000 deductible. The other half of the money would be deposited into a Health Savings Account, also pro-rated.
This would make the individual more responsible for, not only his lifestyle, but what he demanded from the medical system. We would progress toward a system of what is needed as opposed to what is wanted that we have now. “it’s just flat out irresponsible for anyone to spend money on their health care without really thinking through whether that’s money well spent.” – Dr Erik Steele. This would be a control on physicians that tend to bring all the most advanced and expensive diagnostic and treatment to their patients.
It would also get the government and insurance companies out of the doctors office for routine and initial care, and create a bottoms up patient choice system just as we have in all our other industries instead of the top down system you are advocating with its expensive oversight.
Patients can’t possibly know enough to make informed decisions? I don’t know anything about cars or electronics, but I sure recognize good value and quality, and it keeps improving every year.
The next step is for doctors and hospitals to post prices just as other industries do.
Yea but if they posted their prices, how would they then justify charging Anthem $1.00 MaineCare $3.00, and out of pocket payers $10.00 for an asprin?