Maine – the way pain should be

My belief in the principle of shared pain goes back to my childhood, when pain I was suffering as a result of some playground injury could be diminished by kicking anyone unsympathetic right in the shin. My four brothers were good targets. They howled and limped, and I immediately felt better.

The same principle should be applied in the current debates about cutting health care services for the poor covered by Medicaid. At the same time our state governments are talking about cutting care for Medicaid patients, they should be creating a little health care cost-reduction pain for the rest of us.

In Maine and other states around the country, Medicaid programs are gnawing off their own programmatic legs in an attempt to get out of state budget-deficit traps, with resulting pain for Medicaid patients. Medicaid patients may lose access to rehabilitation, dental, mental health and other services. That pain and sacrifice will be felt by the most vulnerable elements of our society; the mentally ill, the disabled and poor children.

The rest of us are unwilling to pay higher taxes to avoid such cuts in part because all of our living costs are going up, especially our health care costs.

Why should Medicaid patients be the only target of state governments seeking to rein in health care costs? It seems only fair that at the same time Medicaid patients are being asked to bear more pain because of rising health care costs, the rest of us should also bear some pain, especially pain that would save us all health care dollars. After all, cutting health care costs for the rest of us saves us all money, helps business save money and perhaps create jobs, and thereby may help raise tax revenues. Besides, Medicaid patients aren’t the only ones who spend the money of others on their health care; we all do it. Medicaid and Medicare patients spend our taxpayer dollars, but you and I spend premium dollars paid by others in our insurance plan every time our personal health care costs more than we pay in premiums.

In selecting ways to share the pain of health care spending cuts, our political leaders should first focus on one area where we collectively waste billions of dollars, that being unnecessary injuries. In order to prevent unnecessary injuries, legislatures should look at areas already legislated, and choose small limitations on freedom that can reap large personal and societal benefits. Requiring helmets for motorcyclists, for example, is a small intrusion in a regulated activity that takes place on a public road, with a big benefit in head injury prevention. Telling us how many pork sausages we can eat for breakfast, on the other hand, is an intrusion into the privacy of the home and the deeply personal issue of what we eat.

So here are a few ways politicians could share the pain, save Medicaid and other health care dollars, and give us all that community spirit of being in this together:

. Ban the use of cell phones while driving. This foolish and dangerous behavior in the car has the same deleterious impact on quality of driving as being drunk, and is a frequent cause of car crashes, injuries and deaths. The health care costs to the system are borne by all of us. Anyone who objects should be reminded that they are helping to save health care dollars in a system which does not have enough of those dollars to pay for dental care for children on Medicaid.

. Require helmets for motorcyclists, bicyclists, snowmobilers and ATV riders. Head injuries and subsequent care are a major contributor to health care costs, including Medicaid costs. Many patients with permanent, severe brain injury end up on Medicaid because they cannot work and no one else can afford their care, and most state Medi-caid programs spend millions annually on such patients. The hypocrisy of a society which is cutting necessary Medicaid programs while allowing unhelmeted riding is wonderfully illustrated by the recent proposal from Maine’s Medicaid program (so-called MaineCare) to completely ax payments for long-term outpatient rehabilitation services for head-injured Medicaid patients. We will cut necessary health care for people after their heads get injured but don’t want to tread on their freedom to injure their heads in the first place, an approach that would cause a dog chasing its tail to stop in wonder at something so dumb.

. Pass primary enforcement seat-belt laws – laws which allow motorists to be stopped and fined for not wearing seat belts. This will result in higher rates of seat-belt use than so-called secondary enforcement laws, which require a motorist to be stopped for some other infraction before being cited for lack of a seat belt. Seat belts save lives, prevent injuries and save health care dollars. A society willing to cut mental health services for mentally ill Medicaid children ought to first cut its expenditure of health care dollars by forcing all of us to buckle up.

With any luck, at least one of these suggestions will affect each one of us, leaving us all howling in self-righteous pain; about our right to go unbelted, to feel the wind and bugs blowing through our unhelmeted hair, or to call the psychic hotline while driving. But don’t complain to me; tell some child on Medicaid that you want to protect your right to waste our health care dollars by driving as though you were drunk, or riding without a helmet, but don’t want to pay more taxes for their health care. And if you really don’t like it, next time you see a Medicaid child who cannot get the health care he needs tell him you can now feel his pain.

Actually, even with a good, swift kick in the shins of your personal freedom, you still probably can’t feel his pain.

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.