2012-01-13 / Commentary

Universal health care can’t wait


For the past two years, much time and effort has been spent either opposing or planning the implementation of health care reforms under the federal Patient Protection and Affordable Care Act and in Maine, under the Republican-sponsored PL-90.

Meanwhile, health care and health insurance costs have continued to spiral out of control for the vast majority of Maine people. As Rep. Les Fossel observed in his Jan. 6 commentary, (“MaineCare and the perpetual budget crisis”), MaineCare cost increases are also becoming unsustainable.

Despite assertions by proponents of recent reforms, there is simply no evidence to suggest that increasing competition in the private, for-profit insurance market will control health care costs, just as there is no evidence to suggest that PPACA will be able to bring costs under control.

We are approaching a crisis in access to affordable health care. Sixty-five thousand Maine people are faced with the prospect of the loss of Medicaid eligibility. Thousands more are seeing astronomical increases in their insurance premiums under PL- 90.

This does not include the 130,000 Mainers who are already uninsured. In a recent informal Portland Press Herald poll, 70 percent of respondents indicated that their insurance premiums were continuing to rise, and 11 percent reported having no insurance at all. This suggests that our current patchwork system of health care is working for less than 20 percent of Maine’s population.

How much longer should we wait before we can agree that our health care system is irretrievably broken and recent incremental “reforms” are ineffective? How many families will go bankrupt due to medical expenses? How many people will die due to delaying care or being unable to access care at all?

The best way to control health care costs and to bring quality comprehensive health care to Maine is through a single-payer system. At least a third of the American public, and a majority of Maine physicians, now favor a single-payer system.

Recognized by slogans such as “ Publicly funded, privately delivered,” “ Everybody in, nobody out,” “ Improved Medicare for All,” we call it “Maine AllCare.”

There would be several advantages to Maine AllCare.

Everybody would be in the same program and equally affected by changes in benefits. Eligibility would become a moot point, since every Mainer would be eligible for the program. The conversation in Augusta would be much different if the governor were proposing health care cuts for all Mainers under a universal program.

Eliminating administrative waste would save a great deal of money. In testimony before the Maine Legislature in October 2010, Harvard Professor William Hsiao estimated potential savings in the first year of such a program to be $ 1 billion in Maine alone.

That is far more than any savings the governor would achieve by slashing MaineCare benefits or throwing beneficiaries off MaineCare rolls. Maine could use these savings to provide real health care benefits instead of wasting money on administrative overhead or insurance company profits.

Effective control of the cost of services is much more feasible under one program than it is with multiple insurance programs. Under a single-payer system implementing global budgets and other measures, reductions in the cost and utilization of expensive but marginally beneficial medical interventions would free up money for essential services (including dental care, long- term care, Private Non-Medical Institutional services, and mental health and substance abuse services — all which would be slashed under the governor’s proposal and put thousands of dependent elderly Mainers out on the streets).

The practice of cost-shifting would end, because services would be reimbursed under a single fee schedule or under a system of global payments. Health care providers would no longer charge more for providing the same service to people with private insurance in order to cover costs of providing care for patients with Medicaid or with no insurance at all. Employers would no longer shift the cost of premiums to employees.

Shifting from a for-profit to a not-for-profit financing mechanism would put the focus of health care on healing and health rather than profitability. The culture of health care in Maine — and the U.S. as a whole — must shift away from a business model and toward a health care mission-driven model.

We must fix Maine’s broken health care system. It is time to listen to Gov. LePage’s directive to look “outside the box” and to end our “winners and losers” system of health care.

Maine can follow the lead of our neighbors in Vermont who have taken steps toward implementation of a single-payer system. We can’t afford to wait for universal health care.

DR. JULIE KELLER PEASE is president of the board of directors of Maine AllCare, a not-for-profit organization dedicated to universal, high quality and affordable health care for the people of Maine. She lives in Brunswick. For more information, go to www.maineallcare.org.

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