Rethinking health care

By establishing a health care commission and asking the Maine public to wait a year before expanding services, Gov. Angus King raises expectations considerably. If the commission delivers anything less than a comprehensive overhaul of Maine’s failing health system, the year will rightly be judged time squandered.

The governor tried to lessen expectations, saying that, “If this group can come forward with even one or two solid recommendations, it will have been worth the time and effort.” But Maine already has plenty of individual good ideas for reducing cost and expanding access, several of them in proposed legislation right now. Reports and recommendations abound on the lack of insurance, prescription drug costs, Medicare shortfalls and hospital usage and their financial conditions. The Bureau of Insurance recently examined the state of individual insurance; the Maine Children’s Alliance annually outlines the health-coverage problems children face; the working poor have been the subject of several pieces of legislation in recent years.

The only way to justify delaying piecemeal repairs to Maine’s health coverage system is to provide the alternative of comprehensive reform. The governor’s new commission should examine why state government continues to regard health coverage as merely a pleasant option rather than a necessity to a healthy life. Why employers are burdened with providing health benefits when work experiences in this state and the rest of the country are moving away from the old model of having one job for life to a fast-changing service economy. The commission should also ask questions about the incentive to insurers that makes denial of services more profitable than supplying them; how Tufts and Harvard Pilgrim could be allowed to come into Maine and fail so badly and what the lack of competition means to costs here.

And, most apparent, it must devise a cost-effective way to offer coverage to those who cannot afford it currently. There is some debate over whether the number of Mainers without health insurance is 150,000 or 160,000 or 180,000. The number doesn’t matter: What the King administration already knows is that a large and increasing number of citizens do not have coverage and they come to the health care system late and, therefore, expensively.

Because Maine is nowhere near the beginning of its health-care troubles, simply providing one or two good ideas is not enough. The commission must think about the entire health care system and it must provide results that go beyond the answers already at hand.