A preliminary report on Maine’s largest investigation of a single-payer health care system had both sobering and encouraging news. Assuming the conclusions of Mathematica researchers hold up, the state has learned a single-payer system is by no means free but certainly is less expensive in providing full health care to all citizens that what the current system would be if it covered the 150,000 or so Mainers without insurance.

The interim report is an opportunity for both supporters and opponents of this type of health reform to get a sense of where the debate is going. Lawmakers are expected to consider various proposals for insurance reform this winter, although the various plans may have to wait for budget and tax issues, pushing them into the spring. Gov.-elect John Baldacci has a plan styled on Maine’s workers’ comp reform, Anthem is pushing a plan, a legislative idea would consolidate and expand preventive care to the uninsured. Legislative advocates envisioned single-payer as being at least 5 percent less expensive than the current system.

By 2008, according to Mathematica, covering every Mainer would cost approximately 7 percent more than the current system’s partial coverage of the population. Mathematica was conservative: It assumed health care spending would increase on 37 percent between 2001 and 2004 and then rise another 29 percent by 2008, to reach an annual cost of $10.4 billion. One of the reasons a single payer is able to cover many more people for a small increase in cost, according to the preliminary numbers, is that “the new spending for formerly uninsured and under-insured individuals is offset considerably by reductions in insurer and provider administrative costs and by elimination of uncompensated hospital and physician care.” The latter, referred to generally as cost shifting, is a highly inefficient way to pay for medical care.

Whatever plan Maine eventually adopts, it is worth keeping in mind that there are considerable savings possible in administration and paperwork. Keeping a multi-payer system, with its higher costs for administration, can only be justified if it also includes benefits in quality or savings elsewhere that more than account for the added cost a of multi-payer system.

Former Rep. Paul Volenik, a co-chairman of the state commission that sponsored the study, pointed out that the most generous option considered – a Medicaid-type system in which there would be no co-payments for treatment – would be about $500 million more in 2008 than what is projected to be spent under the current system. That is an interesting point, but the larger issue is whether the rise in costs can be controlled. The burden of health care costs can be lightened over time if their rates of increase can be slowed. More efficient systems are an important part of the answer but the savings are short-term.

Gov.-elect Baldacci can help this debate along enormously by appointing commissioners and hiring staff with expertise and a deep understanding of the health-care system; knowledge keeps ideology to a minimum and greatly increases the chance that Maine will emerge in the next year or so with a far better health-coverage system than it has now. Almost no one can afford to have Maine’s political leaders fail in this attempt.