Health care primer

Nine months after Gov. Angus King asked Maine to wait on major overhauls to its health care system while a commission of well-informed novices looked over the problem, he delivered this week the entirely expected. The final report from his Blue Ribbon Commission on Health Care is an intelligent summary of the difficulties that a lack of coverage brings and a selection of some of the alternatives being discussed to address it.

Just because there isn’t much new in the report – with the exception, perhaps, of the emphasis on personal responsibility for diet and exercise – doesn’t mean that there is anything wrong with it. But if Gov. King was looking for bold ideas, as he said he was a couple of months ago, he must be disappointed. The commission was asked to look at the cost of health care, determine how the costs were allocated, find ways to stabilize costs and suggest ways to pay for services. At a basic level, it met these charges; on another, it merely summarized the legislative debate from one or two years ago.

Its shortcomings are in its lack of depth. The commission, led by former UMaine System Chancellor Robert Woodbury, worried about health care costs running ahead of inflation but offered no detailed analysis of why this was so. It deplored the 25 percent of Maine’s health care budget going to administration and waste but didn’t identify what a proper percentage for administration should be or why Maine’s might be higher than average. It properly identified that most health-care consumers are price blind – they let insurers worry about the price of a procedure – but didn’t go further into how changing patterns of insurance, starting decades ago with Kaiser Permanente, affects utilization.

Two messages are certainly are worth repeating from the report. One is that the government, largely the federal government, controls approximately half the health-care dollars spent in this nation and the $4.7 billion in Maine annually. That means any reform of health care must include reform of Medicare and Medicaid. It also means that for those who worry government will take over health care – too late, it’s happened, although health-care financing is a far different concern than delivery of services.

The second message takes consumers from the vastness of federal bureaucracy to what is on their plates at supper. Health Bureau Director Dora Mills estimates that three-fourths of Maine people die of just four groups of diseases: cardiovascular, including stroke; cancer; chronic lung disease and diabetes. They are largely preventable and largely caused by smoking, poor diet and lack of exercise. The state’s death rate from these places it fourth highest in the nation, costing Maine countless lives. Monetarily, just the smoking-related diseases cost Maine $96 million a year.

The five-member commission was split over what to do about rising health costs, with Mr. Woodbury convinced that national universal health care was the best solution. Famed cabinetmaker Thomas Moser went from trusting the market to sort out the problem to understanding that it never would and so supported a national single-payer system. Husson College President William Beardsley retained his faith in the market, if given a chance without the state meddling in such areas as certificates of need. Mr. Beardsley was joined in part by former legislator Joseph Carleton, who also saw areas of needed regulation. Pamela Plumb, a former mayor of Portland, commented that, “We are the only country in the world trying to run our whole health care system on the private market system and the only industrialized country not insuring health care for the entire population.”

The incremental changes in the past seven years point the nation in a single direction: Universal coverage using market forces wherever practical and government subsidy where it is not. In addition to bedeviling the pharmaceutical industry, Maine government’s role might be to prepare for that eventuality. Perhaps lawmakers during the last nine months have developed further ideas about how to do this.