Outpaced by health care

Today is Fitness Day at the Maine State House, when representatives from a half-dozen groups are expected to tell reporters how important physical activity is for everyone. Today also marks a week since Gov. King released his strategy for lowering medical bills in Maine. Feel free to start with the brisk walks and push-ups at any time.

Gov. King’s strategy is called PACE, for prevention, access, cost containment and empowerment. It is a good plan generally, although it relies in part on speculative insurance reform that risks placing health insurance beyond the financial means of the sickest. It is as broad as possible, but it is also so limited by the state’s lack of authority and resources that it is necessarily a small plan. It is, perhaps, the best evidence available that Congress needs to act on comprehensive health care reform.

The governor is taking the incremental steps he can in a field of rapidly rising prices and an entrenched health care industry lobby in Washington that has a motto of, First, do no harm to our bottom line. The state’s recent fight with the pharmaceutical industry is just a small portion of the battle. Consider that Congress has spent three years debating how many hoops a patient must jump through before being able to sue a health insurer for denying needed care. What chance does a tiny, cash-strapped state have?

PACE is an amalgamation of the two dozen programs and proposals that the governor’s administration or the Legislature has devised in recent years to provide better health care – especially better health coverage – in Maine. There’s nothing particularly new in PACE, but there does not need to be. The problem has been studied extensively and the solutions within the powers of the state suggested regularly. The job of state government has been to implement what it can.

At the heart of PACE is the idea that individuals can do a lot on their own or with just a little help to improve their health and reduce medical bills. Smoking cessation is high on the list, as is measuring Healthy Maine initiatives that keep people out of the doctor’s office. A further idea would allow insurers to develop incentives for people with healthy life styles. Getting people to improve their diets and exercise habits will be difficult – the governor’s team will have to find a way to make doing so fun, satisfying and convenient, a combination health clubs and diet groups have been wrestling with for years.

Similarly, the cost-containment portion includes some regional cooperation and technical changes in areas like certificate of need and prior authorization for certain medications. There will be opposition to all three of these and yet, taken together, they will reduce the state’s total health care bill by only a small amount. A much larger and more fruitful initiative would include a top-to-bottom review of procedures designed primarily to protect physicians against lawsuits; some agreed-on protocols that eliminated unnecessary X-rays or other types of defensive medicine would result in real savings.

Gov. King noted that “there is no one single approach to solving our health care problems or its high cost.” He has, instead, proposed the responsible course: Do as many small things as permitted and hope Congress wakes up in time to see the daily crisis that states, municipalities and nearly all businesses face in health care. PACE is a stack of sandbags to hold back a flood that requires federal intervention to divert.