Longtime health care advocate Joe Ditre of Consumers for Affordable Health Care recently observed that Gov. John Baldacci had three “P’s” in his favor as he tries to overhaul health care coverage in Maine: policy, political will and popular support. The governor has respected policy experts, a commitment to reform and a Legislature that understands how bad the situation is and a public that cannot afford the status quo. Add to that a fourth P, perseverance, and Maine for the first time will have an excellent chance at reform.

By now nearly everyone has heard stories of people choosing between food and medicine, of neighbors going bankrupt over medical bills or of businesses being crushed by annual insurance increases of 20 or 25 percent. The public is frustrated, doctors are frustrated and hospitals are going broke. Maine’s insurance premiums already are considerably higher than the national average and its income is considerably lower, making it one of the most likely states to lead the way to reform.

By June 1, the governor plans to provide lawmakers with a plan to offer affordable coverage to all Maine citizens through legislation developed by the new Governor’s Office of Health Policy and Finance, the establishment of which serves as a demonstration of how seriously the new administration is taking this problem. Instead of more stakeholder meetings and more talk about the scope of the problem, the office’s responsibility is to write a solution that brings health care costs under control. Its leader, Trish Riley, executive director of the Portland-based National Academy for State Health Policy, suggested recently that reform would come through “raging incrementalism,” many small steps focused on the single goal of providing access to high quality care to all citizens at a price they can afford.

The general proposal, as the governor described it during the campaign, would be based on the state’s workers’ compensation insurance model, establish a nonprofit health insurer backed with help from federal and current state support. Some of its savings would come from the government’s purchasing power, allowing them to negotiate with insurers, and some savings would emerge from standardizing and simplifying bills. Still more would come from taking a long-term approach to encouraging good health. It would also create a standard benefit package that could allow consumers to shop for and compare coverage much more easily.

But there must be more than that to affordably extend coverage to the estimated 165,000 Mainers currently without coverage. Americans spend enormous amounts on health care and get a lot in return; they have the expectation that any type of care will be available anytime they want or need it. Third-party payers – whether public or private – shield consumers with coverage from the costs of the services. A successful reform of health care coverage will make users aware of these costs, not by sending them into bankruptcy but by establishing co-pays that reflect ability to pay. Increased competition among insurers, legal protections for doctors who follow accepted procedures, fair federal reimbursement for Medicare and Medicaid all can help flatten the increases that are making health coverage so unaffordable.

It will be noted throughout the process that Maine is about to begin in earnest that it would make far more sense for the federal government to act, so that state after state did not have to go through the difficult process of reforming their health-care systems. It would make sense, but it is not going to happen. A Congress that cannot agree on prescription-drug benefits for the elderly isn’t able to overhaul the entire system. The states will have to lead the way and, given the acute challenges here, Maine will have to lead the states.