PATIENTS AND PATIENCE

Medicaid and Medicare were created through the Social Security Act of 1965. Both have had major revisions since then, notably Medicaid in 1997, when children’s services were greatly expanded, and Medicare in 2002, when prescription drugs were approved as an added benefit for the elderly. Both have had substantial successes providing access to health care to millions of Americans and both have had some failures. Neither is a finished product and never will be one.

Dirigo Health began in earnest in 2004 and has been clucked over by supporters, detractors and the press constantly since. Will it sail or sink? At this time and likely for a long time, that is not a meaningful question.

Dirigo begins with 1,800 enrollees; it is aiming for 31,000 by the end of

the year. The specific question being asked is whether the initial number is enough to indicate that the final number would be reached.

“Based on their projections, they’re failing miserably,” Tarren Bragdon, of the Maine Heritage Policy Center, said in a news story the other day. “We’re off to a solid start,” Karynlee Harrington, executive director of Dirigo Health, says. Maine and the nation already know that government subsidies, parsimoniously passed along in the form of health care expenses, can provide insurance to lots of people without it and get them to the doctor’s office more often than they would go otherwise.

What Dirigo is trying to achieve is more complicated: It wants to raise health care quality, contain the cost of curing illnesses and improve access to care. If, in a couple of years, health care costs statewide are lower than expected and more people are receiving higher-quality care but only, say, 8,000 people have signed up for Dirigo coverage, would the program be considered a success or a failure? Clearly, the number of enrollees is less important than the effects the program has on all of health care in Maine.

Like Medicare and Medicaid, Dirigo must exist as long as health care is an expensive necessity operating outside the kinds of consumer-driven markets that control prices in other fields. But just as the two federal programs, after nearly 40 years, remain open to modification and reform, Dirigo will be remade many times by necessity. Failure occurs only if Maine gives up and the system is allowed to collapse.