The Maine Medical Association’s support last weekend for a “pluralistic system of universal coverage for all Maine citizens” can be looked at a couple of ways. Chances are the majority of members on the legislative task force looking into a single-payer system see it unhappily. The important part of their vote, however, is the follow-up: An anticipated MMA white paper should spell out how the association would affordably achieve universal coverage, and is expected, coincidentally, at about the time the single-payer group finishes its work.

It may seem that no vote among doctors would be needed to support universal access to care. On the surface, it is like Exxon supporting gasoline-powered cars. But Maine doctors are acutely aware of the financial complications that arise when a public insurer sets reimbursement rates for a significant number of patients. Extending coverage to all Maine residents means increased and more timely care, but it could also mean more cost shifting, more regulation and a greater influence from public officials on medical care. The doctors’ support means they recognize that beyond these challenges lies the understanding that proper health care demands insurance coverage.

A “pluralistic system” of health insurance coverage is what Maine has now and what has helped drive up costs even as 20 percent of nonelderly Mainers lack coverage and only half of Maine businesses offer health insurance to their employees. The original resolution offered to MMA delegates offered a default mandate of individual health coverage for all Maine residents, to be met either privately or through a quasi-public agency. MMA members decided this portion of the resolution needed more work, and the suggestion of a white paper looking into this area specifically was accepted.

Affordability, which is to say significant cost savings through administrative cuts and more efficient medical practices, is essential to extending care. One of the attractions of the single-payer model is that it places all doctors and all patients in the same pool, so not only is paperwork reduced but best practices can be examined and implemented statewide. If there are more efficient methods that keep and extend the current system, MMA’s white paper should bring them forward.

The voices of Maine’s doctors will be crucial this winter in the intensifying debate over health care coverage. Their support now of a system that is not single-payer gives them the responsibility of describing how the current broken system can be made to work.