About a year ago, facing a budgetary shortfall, the Maine Legislature had a knock-down, drag-out fight over Gov. Paul LePage’s proposal to save $220 million by throwing 65,000 Maine residents off MaineCare.
At that time, I predicted that the Legislature “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 [all] health care services.” Well, they didn’t. And now they are.
The recently announced “unexpected” cost overrun of more than $100 million attributable mostly to MaineCare will no doubt lead to a repeat of last year’s fight. At the same time, Maine hospitals are clamoring for almost $500 million in past-due MaineCare payments.
The Legislature is now under different management. Maybe the Democrats can succeed where the Republicans failed. But to do so they will have to finally be willing to look at the big picture.
At a national level, Congress and the Obama administration are contemplating cutbacks in Medicare eligibility as one way to reduce federal spending. Such cuts, like those in MaineCare, will simply shift those costs to the private sector.
That shift will only exacerbate existing private-sector health care cost problems. Out-of-control costs have had a dampening effect on employment, depressed wages and discouraged entrepreneurship by creating job lock. They have also encouraged employers to shift whatever costs they can to their workers and to public-sector programs such as MaineCare. Walmart is the poster child for this phenomenon, but it’s hardly alone.
MaineCare cost overruns are only a symptom of larger problems in our health care system as a whole. They cannot be solved in isolation. Trying to do so is a losing strategy.
The Legislature now has an opportunity to revisit a solution they have failed to embrace in the past under both Democratic and Republican leadership — movement toward a single, publicly managed health care system for all the people of Maine.
Such a system would cover everybody, and would be a big step toward eliminating the billions of dollars of health care waste due to fraud, overtreatment, inefficiency and unnecessarily high prices. It could do so for no more than we are now spending.
It would also enable us to control total health care spending in ways far less intrusive than our current system. How is this possible? Here’s an analogy.
If a rancher has a herd of cattle and wants to limit their grazing to a limited amount of land, he can accomplish that in one of two ways. He can either tether each of the cattle to a leash (and hope they don’t find a way to break loose) or he can build a fence that effectively encloses all of them in their pasture. Controlling the entire herd is both more effective and less intrusive than trying to control individuals.
In health care we have tried tethering (mostly through private insurance companies) by restricting the individual actions of both health care givers and patients. It hasn’t worked.
A single, publicly financed and managed health care system will permit us to create a fair, unified, simplified and enforceable budget for all health care in Maine, while at the same time reducing our intrusive management of individuals’ health care decisions. It would give everybody in Maine a stake in seeing to it that the system that includes everyone works well for everyone.
As I’ve written before, Obamacare is in some ways a step in the right direction, but it’s far more complicated than need be and will not be as effective in constraining health care costs as it must be. But it does contain provisions that would permit Maine to set up a program that would provide the tools to manage the competing claims and objectives of different stakeholders. We could simultaneously improve access to care, the quality of care, and restrain the rise in costs for everyone in Maine.
I hope the Legislature takes a serious look at this approach in the coming months as they struggle with their daunting budgetary challenges. It will not be easy. That’s why it hasn’t been done before.
But if we are willing to treat the underlying pathology of our health care system instead of just the symptoms, we will have taken the first step toward fixing it. If not, we will be fighting the same fights next year and the year after.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.
I agree and fully support your proposal. If only we could prevent the insurance companies from undermining such a plan through their bought and paid for politicians. I’m afraid the medical community is also addicted to and committed to the status quo. You are right that a single payer within a single state is the right idea and this had been the hope at the federal level until the affordable care act was overtaken by lobbying money.
“Maybe the Democrats can succeed where the Republicans failed. ” Huh? It was the Democrats that got us into this mess. Republicans only had 2 years to begin to undo what took decades of irresponsibility to create.
Single payer, within a single state, would be lunacy. The traffic jam coming in to Maine to take advantage of this deal would be something to behold. Health care costs will never be controlled until patients become “consumers” of health care. If there is no consideration given to what health care costs, there is no incentive for consumers to “shop.”
I agree. Competition is the key to lowering costs.
“Shop” for healthcare? Works for the low-budget stuff perhaps, but just try “shopping” for healthcare bargains on the way to the ER with a serious injury, heart attack, or stroke.
Oh Liz, I haven’t had a stroke yet but I have had 2 serious accidents, and a heart attack. Helicoptor evacuations were ordered twice. I cancelled them both. It is foolishness, and saves very little time, while putting you in additional danger. Doctors order them because they don’t want to be sued. Once confirmed, treatment options are discussed and you can make your own decisions about aggressive treatment or very little treatment as I discovered. The first thing the doctor will say is “you may die”. You are frightened into the most aggressive treatment. That way the doctor won’t get sued. Ask the doc to explain WHY. You may be surprised at the lame answers you get. While on the table to get stented and a pacemaker I asked WHY, and both doctors mumbled and quietly faded away. Treatment cancelled. 6 years removed and healthy with the baby aspirin treatment. Patients can shop for ALL healthcare wisely.
You made some wise choices in those circumstances. Could you have made them if you’d been unconscious? Had a traumatic brain injury? Been bleeding out?
You would likely not be up to selecting the least expensive hospital for the ambulance to take you to, and if you had become cognitively impaired (even temporarily) you’d be in a poor position to study up on the services, practitioners, and cost-benefit analysis in local vs. more distant hospitals.
Can a person that pays for their insurance go to the er for a headache at least once a week and not have to pay a large co pay? Maine care recipients can and not one dollar out of their pockets for a headache. Do you see something wrong with this? I do. If you go to the doctors office and have insurance your insurance company gets charged 300 to 400 dollars for the visit but if you do not have insurance you pay 90 do you see a problem with this? I do. Something has to give. I have seen children on maine care with braces i do understand sometimes it can be medically necessary but i have seen alot of them what gives with this? The politicians need to get their heads together and find some solutions so that all will be able to afford health care and not just have maine care recipients have the best care time for a change.
Before we realized that ObamaCare is another step towards total political control of our economy, I had hoped that “possibly” Obama might do as you say, “eliminating the billions of dollars of health care waste due to fraud, overtreatment, inefficiency and unnecessarily high prices” that has been going on for YEARS in our existing single payer system known as MEDICARE. Prove yourself by fixing Medicare first.
It’s all political smoke and miirors. You folks saw it. Initially, it was health care reform (yea hurrah), then you sheep accepted the change to health care INSURANCE reform with nary a peep!
Great article, totally agree.
Vermont is going single payer, wouldn’t it be nice if a northeast single payer system could be created.
Dr Caper, You always take the far left liberal view.That view is “this is too much for the average person to navigate so let the government do it”. Would you once step out of your shoes and into the far right view of individual responsibility. Paying for health care collectively has provided this pool of money for drug makers, instrument makers, insurers, doctors, and patients to just reach in and take what ever dollars they wish without a care in the world about costs.
You would have the same pool of money and direct all care from the TOP. While checking the rule making of the ACA I noticed they were on page 71,282. Top Down in action. What is the cost of 71,000 pages of rules and their enforcement. And are you sure you will get all the treatments right. Or will we suffer at the hands of a bureaucrat.
Give us a high deductible and return the rest of the money to the individual (Health Savings Account) so we can make our own decisions about healthcare using a primary doctor as a gatekeeper. You will be surprised at how quick we will find cost effective solutions and how fast the healthcare industry adapts. The added benefit will be the incentive to live a healthier lifestyle because we will be spending our own money.