Study single-payer

The switch from a bill to create a single-payer health care system in Maine to a broad study on the issue was compromise enough to get it through both legislative houses and it should be enough to persuade Gov. King to sign it. Sign it, and contribute to the options that would be examined.

The idea behind a single-payer system is simple enough. It takes the responsibility of paying for health care away from businesses and hands it to taxpayers. It depends on administrative efficiencies and limits on coverage to save money. It includes everyone, rich and poor, to spread costs as far as possible. The actual workings of such a system, however, are complicated, and there is nothing wrong with lawmakers taking their time on this issue.

The study supported by the Legislature began as LD 1277 by Rep. Paul Volenik of Brooklin. It would have offered a system based on the services under Medicaid, with no deductions and limited co-payments. Residents would have chosen their private health care provider. Though the bill would have taken effect a couple of years from now and only after a 25-member commission gathered public comment and worked out its details, the Senate remained cautious. Instead, the study of this plan and related issues on single-payer can now provide an opportunity to explore the strengths and weaknesses of the payment method.

Gov. King clearly doesn’t much like single-payer, but he should still approve the study bill if for no other reason than to put to the test his reasons for not liking it. The governor would appoint most of the commission members, so he has some opportunity to name people who share his skepticism. He might recall that the majority sentiment of his own Blue Ribbon Commission on Health Care last year leaned toward national universal health care. The Volenik bill is a natural follow-up to that conclusion, and a chance to see what would happen in Maine if it became a leader in this reform.

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One of the several balances a single-payer system must maintain is between cost and access to care. It is one thing to save on administration, but to reduce the rate of increase in costs means doing something about the cost of the actual delivery of services. It is fair to ask whether a nation accustomed to having all the medical care a third party is willing to pay for would restrain itself under single-payer. An income-based deductible and co-pay feature, however, might provide the proper controls on cost and should be studied by the bill’s commission.

Another balance in single-payer is between taxation and reimbursement levels. What everyone wants, of course, is an excellent health care system that doesn’t cost them personally. A health insurance tax would be substantial (so, naturally, would be the savings from avoiding insurance bills). But unless enough funding were put in the system, lawmakers inevitably would tinker with payment rates to doctors and other care givers, which would cause the medical professionals to start looking at want ads in other states. Tying the system to established payment rates could solve this problem, but, in any event, the taxpaying public would need to be prepared for the shift from insurance payments to taxes.

A third issue, raised by opponents of the bill, should be studied so it can be dismissed. Hoards of people, they say, with expensive diseases, chronic conditions and – who knows? – really stuffy noses are said to be poised at the Maine border, ready to take up residence here if single payer passes. It would be interesting to see the documentation on this. Those in other states who are so ill that they are not working are very likely to already receive Medicaid, so they would have no incentive to leave their home state for essentially the same coverage in Maine. Those not especially ill, willing to work and attracted by Maine’s health system should, of course, be welcomed in a state that ranked among the slowest growing in the last decade.

That leaves those out-of-staters who are not sick and not interested in work. Why this group would be attracted by a health system they don’t particularly need is unclear. Why lawmakers would worry about people coming here and not needing a theoretical health system is equally unclear. Maybe the commission could find out.

The governor should at least agree that the direction of the current financing of health care is not long supportable by individuals and businesses. He might further agree that the cost controls under managed care are no longer working and that a different approach is needed. The single-payer commission would explore how this type of reform would work in Maine. Given the crushing costs of paying for care these days, this review is badly needed and one the governor should support.