By Philip Caper, M.D.
Bangor (Maine) Daily News, Oct. 16, 2014
Elections matter. And when it comes to health care, the upcoming election on Nov. 4 will matter a lot. This seems an appropriate time to take stock of where we stand.
I strongly believe in health care with dignity for everybody. When I took the Hippocratic Oath, I swore to put the patient first. That means treating people according to their medical needs, not their employment status, net worth, place of employment, age, gender, lifestyle or where they happen to live.
The United States spends more on health care — about 50 percent more — than any other wealthy country. Despite continuing to pour more and more money into health care, we still rank behind those countries on infant mortality, life expectancy, health care quality and access to needed care. The fact that we continue to do so every year tells us we need new thinking.
Where is all that money going? According to the Institute of Medicine, we in the U.S. waste $750 billion a year on our broken health care system.
The Affordable Care Act is a first step in trying to repair it. Offering federal subsidies for private insurance, expanding Medicaid and neighborhood health centers and regulating insurance industry abuses are important advances. We shouldn’t toss them aside. Repealing the ACA, as many conservatives propose, would be a disaster for Maine and for the country — unless we replace it with something better.
The ACA is in some ways a step forward, but it is not enough. Even with greatly expanded coverage, too many Americans will not see the benefits they would with a universal health care system.
Maine is the only state in New England that has failed to expand Medicaid and is one of just two states in the country where the number of people without health insurance increased in 2013. Expanding MaineCare would cover an additional 70,000 Mainers at almost no cost to the state and would inject nearly $1 million a day of federal revenue into our economy. Failure to do that — because of Gov. Paul LePage’s vetoes, sustained by Republicans in the Legislature — has cost the people of Maine more than $300 million so far.
We can do much better than that. We need a simpler, less expensive system that includes everybody. We already have such system for seniors — it’s called “Medicare.” When Medicare was implemented by the federal government in 1965, 19 million people were enrolled within nine months, using index cards. There were no software glitches, no crashing websites and little confusion. There was no need to re-enroll every year. Once people are enrolled in Medicare, they stay in it for life.
We need to extend the benefits of Medicare to every Mainer and to every American. There are two ways we can accomplish this.
Congress could pass a new law expanding Medicare. There are bills in the House and the Senate that would do that. But we don’t need to wait for new national legislation. There is another way.
Starting in 2017, existing federal law allows individual states to design their own health care reform if it provides at least as many benefits at no greater cost. No more exchanges, mandates on businesses and individuals to buy private insurance, or hard-to-enforce tax penalties.
That opportunity shouldn’t be missed. Our neighbors in Vermont already have passed a law setting the goal of a single publicly financed health care system to include every Vermonter. They are now moving forward to implement that law. Rather than cutting more people from the rolls, Maine should retake its position as a national leader in health care.
The popular and successful Canadian health care system, which was once almost identical to ours, got started in one province: Saskatchewan. It was so successful that within 10 years it spread across the country.
According to William Hsiao, an internationally respected Harvard health care economist, we could save $1 billion a year in unnecessary administrative costs in Maine alone by making fundamental changes in the ways we finance health care. The money we save could then be invested in roads and bridges, improved public safety and educating our children. It would result in higher wages for our workers and would stimulate the creation of new businesses. It would free our people up to pursue their dreams, instead of being stuck in dead end jobs just to get health care benefits.
But those changes can’t and won’t be made without the full and energetic support of our people, our governor, our legislature and our entire congressional delegation.
That’s worth thinking about when you go to the polls Nov. 4.
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 or through his website at philcaper.net.
