Change of shift

Sometime in January, when winter is so bad that Maine is the way life should be only if life should be hell, there will be a change of shift in Augusta. Gov. Angus King will sign out to Gov.-elect John Baldacci, the new governor coming on duty. If Maine was an ER, King would be leaving Baldacci a pile of sick patients, and Baldacci might be thinking that perhaps he really should have gone to Disney World. The patients King is leaving behind are, for the most part, the same ones who were waiting for him. Now they are just sicker, because they never really got treated.

In Maine’s ER, Room 1 was occupied by the Tufts Health Plan, but it coded and died. In Room 2 is still Maine Medicaid, previously looking for infusions of cash but now looking like it is going to have to be bled white to help close a huge state budget deficit. There is a tube coming out of its arm with blood running through it, but the blood is running out, not in. In Room 3, nearly psychotic in desperation over rapidly rising health insurance premiums, are Maine’s businesses. In Room 4 are still Maine’s hospitals, most of which lost money last year and all of which look a tad pale.

Still in the waiting room are 180,000 Mainers with no health care insurance, and that waiting room is as packed as ever. Worst of all, outside the packed ER it is raining red ink on a state budget deficit that looks like $250 million now and perhaps more than a billion dollars in the next biennium.

“Doc” Baldacci is a man with a health plan, however (you can find it on his Web site www.baldacciforgovernor.com). While that shouldn’t surprise anyone – a politician without a health plan would be like a moose without lips – Baldacci may do things differently, increasing the odds that his plan will do more than look good on a Web page. Baldacci’s health care plan has specific goals, a new concept in Maine where heretofore the Ouija board appeared to be the state’s principal health care policy planning tool in most areas other than disease prevention.

Second, and more importantly, Baldacci has made the development of a state health care plan which covers all Mainers one of the principal goals of his administration. King never made such a commitment, nor has any other governor previously done so in this state. Baldacci’s plan says that “on day one of my administration,” he will name “an action group of consumers, purchasers, providers, businesses, and insurers” to develop that comprehensive coverage plan. He will then take it to the Maine Legislature for approval.

Cool, but not yet “way cool” yet, as my daughters would say. Baldacci has to deliver results on moving Maine out of its health care cost crisis, something else no Maine governor has yet done. He can only do that by taking a risk; he must personally invest his power, prestige, and persuasion to get the job of his “action team” done. If Baldacci is to give Maine the shot in the health care can it needs, he will need more than the penicillin of his plan and the syringe of his action group. He will need to deliver the medicine himself, personally leading his “action team” to success.

Otherwise, he might as well fill the syringe with Valium and just sedate the whole ER for the duration of his administration so that the patients don’t realize they are not really being treated. That is the lesson of Governor King’s Blue Ribbon Commission; its ideas have come to naught in part because King’s prestige was not attached to implementation of the commission’s recommendations. While its accomplishments in health care were substantial, the King administration made little progress in developing a comprehensive approach to the state’s health care cost problem.

A good doc needs a good team to get the job done, and Baldacci will need the investment of the constituencies represented by his action group in collective solutions, something they have never done. Maine’s doctors, hospitals, insurers, patient groups, and businesses have fought like children in the back seat while the state’s healthcare minivan headed for the precipice. That will end, one way or another, but probably disastrously if Baldacci does not take the wheel personally.

Finally, the new governor needs his action group to be an Energizer Bunny whose permanent job is to keep coming up with great ideas which improve quality and cut costs in health care. His plan calls for the perfect group; consumers, payers, providers, insurers, business, etc., all backed by the power of the governor and state government, and attached to the state legislature. He needs to staff it with a couple of health care policy experts, an epidemiologist, and his right hand man or woman, and make it a permanent health care skunk works for good ideas hot wired to health care policy development.

With all that and some luck, “Doc” Baldacci ought to be able to clear out his ER.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.