May 27, 2018
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Eliot Cutler: To grow Maine, health care reform a good place to start

Eliot Cutler
By Eliot Cutler, Special to the BDN

Maine’s economy is stuck in neutral, a victim of bad choices made by both Democratic and Republican governors. It’s time for bold changes and reforms that will make Maine once again a state of growth and opportunity.

Maine’s health care system is a good place to start. We are spending too much for health care in Maine without getting the value we deserve.

Maine has the 5th highest health care spending per capita in the nation, 25 percent higher than the national average. Our health care system imposes hidden taxes on Maine citizens and acts as a major drag on our economy.

Senseless partisanship led Maine to leave on the table hundreds of millions of dollars in federal funds under the Affordable Care Act. These funds would have provided coverage to 70,000 Mainers and could be used to plan a new universal health care system right here in Maine. Maine taxpayers are now paying for better health care for citizens in other states while our governor turned his back on Maine’s own share of those benefits.

Too many Mainers today are uninsured and dependent on expensive emergency room care. Others are covered under expensive plans where health insurers and providers recover the costs (and more) of providing care to the uninsured. This is driving our costs higher, isn’t working for anyone – and it’s unfair.

If we want to grow Maine’s economy and create opportunity for all Maine citizens, we need to get health care right, and that means providing universal access to quality health care, period.

Maine’s problems are largely of our own making. They aren’t caused by federal policies and won’t be fixed by Obamacare.

The lion’s share of avoidable costs in Maine’s health care system can be traced to excessive equipment and facilities driving unnecessary procedures; to costs imposed by a claims-based system; to weak incentives that fail to encourage healthy behaviors; and to the failure to provide primary and secondary preventive care to all Maine citizens.

We’ve known all this for years. Yet, against this background of high costs, excessive spending and diminished access, Maine has taken too many steps that are making our problems worse.

  • Public oversight of health care systems’ spending is too limited. Incentives to order expensive procedures have largely gone unchecked, further escalating costs.
  • Insurance companies can now charge more for less, too often without getting permission from the Bureau of Insurance, while receiving a $22 million subsidy from taxpayers in the bargain.
  • Because Maine opted out of the Medicaid expansion under Obamacare and booted folks off the MaineCare rolls, tens of thousands of Mainers depend for care on the emergency rooms of Maine hospitals, driving costs higher, opportunities lower and increasing hospital debt all over again.

We can make Maine more competitive as a place to live and to work by applying traditional Maine concepts of value and innovation to our health care system, achieving a healthier population and workforce at a lower and more sustainable cost. Some of the principles that ought to guide a better approach include these:

  • Every Mainer needs a “medical home.” Universal access to primary and secondary preventive care can lower the incidence of acute and chronic diseases and accidents and reduce the complications of unavoidable chronic illness.
  • Maine’s health care system should reward high-quality care and positive outcomes — not high volumes of procedures.
  • Maine should have emergency and ambulatory care centers in community service centers with telemedicine links to major medical centers; enough ambulances and helicopters to transport patients who urgently need higher-level care; and high-functioning, critical care hospitals in sensible locations.
  • Incentives for healthy behaviors should cause patients and providers alike to have “skin in the game,” sharing responsibility for good health care outcomes.
  • Efforts to improve physical and mental fitness and a more robust public health effort can help assure employers that they can find a healthy workforce and a safe and healthy environment here in Maine.

Most of us in Maine believe in fairness when it comes to health care. Whether they are old or young, employed or unemployed, whoever they are and wherever they live, all Mainers should have access to health care – because it is the right, fair and morally responsible thing to do, and because it is the financially and economically smart thing to do. Making certain that the care is appropriate and not excessive is the fiscally responsible thing to do.

With universal access to essential health care services, Maine can muscle down our health care costs — while staying in the top tier of America’s healthiest places and making Maine more competitive as a place to live and to work.

Eliot Cutler will be an independent candidate for governor in 2014. This article is adapted from a forthcoming book.

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