Advancing Dirigo

It would be hard to overstate the importance of the unanimous agreement Monday night from a special legislative panel formed to review Gov. John Baldacci’s bold health care reform. The plan its members approved is not perfect and it is not finished, but it supports the most serious attempt yet to provide health care to all Maine residents while making the system more affordable and maintaining or even improving the quality of care. It is a remarkable achievement in a short time.

Major health care reform, including universal access, has been tried several times in Maine before, but it has just as often failed because of its cost, ideological differences among lawmakers over the role of government in health care or plain fear that reform would make a shaky system worse. Time has taken care of cost and fear – health care coverage is so expensive now that business owners statewide are eager to see a system that doesn’t add tens of thousands of dollars to their costs each year, even if that means taking a chance on reform. Ideological differences persist, but among those who would prefer to see the government stay out of health care, there is the recognition that the current market system is not working – in part, some would argue, because of government mandates – and that health care is not like most other commodities.

What brought the committee to bipartisan agreement was its willingness to compromise to find an agreement. It was an example set early by the Baldacci administration, which has not let pride of authorship of Dirigo Health get in the way of seeing it become enacted. On Monday, Trish Riley, director of the governor’s Office of Health Policy and Finance and creator of the plan, said members of the committee had kept the key portions of the bill intact even as they negotiated over details. “The substance of our bill is all there – cost, quality, access,” she said. “They strengthened it, and people agreed to it.”

The changes in the bill protected some of the interests of doctors, backed off on potential costs for hospitals and included incentives for insurers to send patients farther to get nonemergency care. But the core of Dirigo Health remains. It will, over five years, phase in subsidized health care to all who need it, thereby reducing bad debt and charity care, hold down costs through voluntary rate caps and toughening the process by which the operators of medical facilities show need to expand, share more information so costs can be more easily understood and monitor quality closely.

Eventually, perhaps even soon after the program begins next summer, the administration will likely spend time examining increased utilization of services and looking for ways to encourage the most cost-effective types of care. Expect to hear a lot next summer about sensible diets and exercise – and perhaps even more about copays and deductibles. The public expects a lot from health care these days; Dirigo Health spells out in ways not usually seen what those expectations will cost. This transparency may eventually be the most valuable part of the plan.

For now, however, the administration and legislators deserve credit for advancing this crucial legislation. They have a long way to go before offering Dirigo coverage, but they have moved Maine far ahead of where it was just a few months ago.