By PHILIP CAPER, JOE LENDVAI and JULIE PEASE
The Portland (Maine) Press Herald
February 6, 2011
There has been a great deal of discussion recently about health care reform in America and in Maine. Many Republicans want to repeal last year’s federal health care reform law, and most Democrats want to implement and improve it.
In the meantime, pending full implementation of the law in 2014, health care costs for individuals, employers and the government continue to soar, and the number of uninsured Americans (including Mainers) continues to grow.
Many Americans believe that the forces of the marketplace can solve our health care problems. They won’t, and they can’t. We have been trying marketplace solutions for more than 30 years.
These “solutions” have led to out-of-control costs, rising numbers of uninsured and under-insured patients, the disappearance of primary care providers, fragmented and duplicative care, and a brutal system dominated by for-profit health insurance companies.
In this system, denial of care is the means to increasing profitability. Marketplace solutions have failed.
America spends about twice as much per-person on health care as the average of all other developed countries, even though those countries are able to provide health care to all of their residents.
Furthermore, by almost every measurement, other developed countries have better health care outcomes than we do, and their health care systems are almost universally popular with their people (including their politicians).
How do they do it?
First, only in America is health care considered a business. The mission of a business is to create wealth for its shareholders.
The mission of a health care system is to prevent disease where that is possible, and to diagnose, treat, cure, heal and comfort patients when they are ill.
Only in America has the business mission been permitted to trump the health care mission.
In all other developed countries, health care is financed by the government or nonprofit funds that are tightly regulated by government and run as public utilities. The for-profit financing of health care is not permitted for basic health care services.
Second, only in America is there such fragmentation of health care systems, with multiple tiers of care provided by Medicare, Medicaid, the VA, Tricare and private insurance.
In most other developed countries, everybody is in the same system. With everybody in the same system, everybody has an interest in seeing that the system is adequately funded and run effectively and efficiently.
Third, all other countries have some way of budgeting for health care for all of their citizens.
In America, the system for the civilian population is totally open-ended. Neither the federal government nor the states has yet shown the political will to control costs.
Some states are beginning to apply the brakes, but only if cost restraint is applied selectively to their most vulnerable and politically disenfranchised populations.
It is time for Mainers to replace our fragmented, expensive and fundamentally unfair health insurance system with a single statewide program of health care financing — everybody in, nobody out.
In recent testimony before the Maine Legislature, professor William Hsiao of Harvard University, one of the world’s leading authorities on the financing of health care, estimated that Mainers could save $1 billion in the first year of such a system, and permanently reduce the rate of health care cost increases by 2 percent per year thereafter.
Some of the savings would come from eliminating excessive insurance company profits and executive compensation.
More would come from standardizing benefits and coverage, eliminating the huge administrative costs that doctors, hospitals and other providers of health care incur in dealing with hundreds of plans.
Still more would come from eliminating the fights about money that are a byproduct of so many different insurance programs — who pays, what for, how much — that now consume so much time and effort, and impede the delivery of quality health care.
Replacing our profit-driven system of financing health care with a mission-driven nonprofit system is the necessary first step in reinventing health care in Maine.
Only then will we be able to address the need to effectively reform the way we pay hospitals and other health care providers to reward efficiency and outcomes, rather than profit and volume.
Maine AllCare proposes nothing less than reforming the culture of health care throughout Maine.
Maine AllCare’s vision is for a system for Maine in which:
• All Mainers have access to affordable and appropriate health care and its supporting social and community services.
• No Mainer is in danger of financial ruin because of health care costs or is locked into a job solely because it provides health insurance.
• No Maine employer is faced with health care costs spiraling out of control.
• No Maine worker is faced with stagnant or declining wages or the inability to bargain for better working conditions because of the rising cost of health care.
• Maine patients will no longer have to wonder whether their doctor’s treatment decisions are driven by their health needs or their insurance coverage.
• Maine doctors will no longer have their clinical judgment second-guessed by insurance companies. Medical practice will be decided by health care providers and patients, and will return to being driven by mission, not money.
• Maine hospital executives will be free to offer services determined by the needs of their community, not their need or desire to generate revenue.
• The Legislature will not have to stand by and watch rising MaineCare and state and local government employee costs steadily erode its ability to address other critical priorities.
Can it be done? Absolutely. There are plenty of examples from around the world. All other industrialized countries, many less wealthy than ours, are already doing it.
Can we do it? That depends upon the people of Maine.
The authors serve on the board of directors of Maine AllCare, a nonpartisan, nonprofit group committed to educating the public and policymakers about how to improve on the Patient Protection and Affordable Care Act to make health care in Maine universal, accessible and affordable for all.