Two weeks ago I wrote my first letter to my senators and representatives here in Maine not only on behalf of myself but also on behalf of the majority of the emergency physicians in Maine. I did so because of the concern that I have regarding the Dirigo health plan currently being considered by the Legislature. I oppose the health care reform plan introduced by Gov. Baldacci. Although I applaud the efforts of the governor regarding this well-intentioned proposal, I think that it is unrealistic, and will severely impact the medical infrastructure of Maine.

I came to Maine in 1996 and did my emergency medicine residency at Maine Medical Center. For the past four years, I have been practicing as an emergency medicine physician at Central Maine Medical Center as well as Maine Medical Center, Rumford, Bridgton and Parkview hospitals. I am also the president-elect of the Maine Chapter of the American College of Emergency Physicians.

Emergency departments are America’s “safety net,” providing care for our State’s uninsured citizens. Emergency departments practice under a federal mandate requiring us to provide healthcare to anyone who comes through our doors regardless of the hour or their ability to pay. We willingly provide this care and have never deviated from our high quality standards nor based it on the economic or insurance status of our patients. We practice this way because not only is it the law, but it is also the right thing to do.

The governor’s plan stipulates a severe reduction on hospital expenditures. This rationing of healthcare will severely weaken and probably destroy the hospitals where we practice. Many of my fellow colleagues have already begun the difficult process of looking for jobs and opportunities in other states. Financially weakened hospitals will not have the resources to maintain an emergency room. Citizens of most rural Maine communities will suffer needlessly since they will need to travel far distances to a surviving regional emergency room when lifesaving treatment is needed. Tragically some of these Maine citizens will die due to the closure of rural ER’s, which we believe will happen under the governor’s current proposal.

The irony is that Maine people will have health care coverage, but no local hospitals or emergency roooms in which to receive not only routine care but also the care, which is truly lifesaving.

Health care reform and regionalization has already been tried in Montana and Oregon and the result was harmful to community hospitals in those states. In Massachusetts 40 hospitals were closed over a ten year period. Rationing has also been tried through HMOs; forced prior authorization for tests and life-saving procedures has created nightmarish red tape, long waits for tests and procedures, and has become hugely unpopular both for the patients and their physicians.

As a leader of the state’s emergency physicians, I can adamantly state that we are deeply committed to the notion that the people of Maine should have access to quality, state of the art, comprehensive and affordable healthcare. Unfortunately although this plan sounds wonderful to some, it is unrealistic and misses the mark.

By instituting a global spending budget for hospital care, the governor’s plan rations health care services in Maine. Decisions about what services are available for patients and where those services are provided will be taken away from local communities, doctors, and patients and instead will be given to state health-planning bureaucrats.

It is also unrealistic to expect that hospitals can trim what they spend on overhead, drugs, equipment and buildings. In the majority of cases, hospitals have no control over these costs which are established by other state and national companies. Furthermore, global capital spending caps will not allow Maine hospitals to replace aging and inefficient plants and equipment.

I hope that as our senators and representatives consider this legislation that they remember that Maine Hospitals are community oriented charities, providing valuable services to the communities they serve; and especially in regards to the golden hour associated with trauma and cardiac care.

Since writing to a broad base of representatives and senators as well as the governor several weeks ago; I have been disappointed and dismayed over the scripted replies that I have received. Many of the replies are very close-minded and naive regarding the lack of details and planning for the proposal. Perhaps the most disheartening trend of replies I have received are from those legislators that say doctors should get on board this reform “train” or leave. This attitude is not beneficial to either side.

Health care can be reformed without unnecessarily destroying Maine’s non-profit hospitals. The current plan has been hastily created with minimal input from those who actually provide the majority of health care in the state; the most egregious fact though is that it is being rushed through the legislature with the hope of minimal opposition.

Health care reform is needed and the governor’s proposals are bold but we should tackle these problems slowly, individually, and sequentially to allow for a far reaching plan that will work now and in the future, that all parties can utilize willingly, and a plan that can be a model for other states to build upon.

To accomplish a health care plan that will benefit everyone in Maine, from the richest to the poorest, we must take the time to study the current system, to learn from past mistakes and carefully and thoughtfully plan for the future long-term health care of Maine; to do otherwise would be an injustice to all of the citizens of Maine.

Kevin M. Kendall, M.D., FACEP is president-elect of the Maine Chapter of the American College of Emergency Physicians, and assistant medical director emergency medicine/EMS CMMC, regional medical officer, western Maine.