By Philip Caper, M.D.
Bangor Daily News, Jan. 19, 2012
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 rolls, 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.
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 email@example.com.
http://bangordailynews.com/2012/01/19/health/do-we-need-to-gut-mainecare/ printed on January 20, 2012