QUESTIONING HEALTH REFORM

So philosophically opposed to single- payer health insurance are the business interests lined up against it, said one speaker at a recent Augusta rally on the subject, that they will try to distract the public with questions that do not provide answers to the problem of providing access, maintaining quality and controlling cost. The challenge for the people who eventually pay the health care bill, which in Maine tops $5 billion annually, is to sort the good from the merely distracting questions.

The head of the state Chamber of Commerce disagreed, telling a reporter that his questions were the right ones. Among them are the following: What would a single-payer system cost? How would it be financed? What services would it cover? Why are health insurance premiums rising so rapidly?

All fine questions and all questions that have been answered before as various single-payer proposals have been put forth. But an important question is missing from the list. That is, how does single-payer compare with the current system for quality and cost? And just as important, how does it compare with other alternatives? If the rising cost of health care is as unsustainable as it appears, nothing short of a major overhaul of the system will solve the problem. Such an overhaul may take years and be accomplished incrementally, but it will come because the public cannot afford otherwise.

So when any group opposes single-payer as a solution, the next comment ought to be a detailed explanation of what it does support and how it would be funded. The Maine Medical Association recently concluded single-payer was not the way to go, but offered nothing as an alternative except a promise to come back this fall with a better solution. The MMA vote came six to eight weeks before the largest Maine study ever conducted on single-payer was due to be released; whatever findings the legislative task force are to provide apparently were not of sufficient interest to hold up the doctors’ rejection of the system.

The speaker who offered the warning at the rally, Dr. Lawrence Wallack of Portland, Ore., quoted the novelist Thomas Pynchon’s book “Gravity’s Rainbow”: “… if they can get you asking the wrong questions, then they don’t have to worry about the answers.” But even asking just some of the right questions is not enough.

Single-payer may turn out not to be the right answer, or it may be an answer in need of modification. But to dismiss this answer before the debate to occur this winter has begun is to follow Mr. Pynchon’s observation exactly.