Forum explores public ideas on health care ‘Tough Choices’ puts everyone in charge of reform

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ORONO – The message to Augusta is clear: All Mainers have a right to affordable health care, and the state should invest in preventive medicine to bring down costs and improve health.

What is less clear was how these ideals should be achieved. But organizers and participants at the state’s Tough Choices in Health Care discussion, held simultaneously on Saturday at the University of Maine and the University of New England in Biddeford, said the primary goal was reached: to get workaday Mainers talking about the hard realities of reforming health care in Maine.

Tough Choices was organized as way to determine Maine residents’ priorities and engage their support in creating change in Maine’s health care system.

“We hear from experts and lobbyists all day long,” said Trish Riley, director of the Governor’s Office of Health Policy and Finance. “We’re trying to get a public discussion going, to get to the point where everybody’s a stakeholder in the health care system.”

Originally scheduled to take place in March at three electronically linked sites, the Tough Choices event was postponed because of bad weather. Only about 300 people – less than a third of the original goal – participated in Saturday’s two-site exercise. The Muskie School of Public Service at the University of Southern Maine selected participants to reflect the state’s demographics in age, gender, race, educational level, household income, source of health care coverage and other factors.

On Saturday, participants sitting at randomly assigned tables of six or seven were asked to discuss and vote on four general strategies for change: improve personal health status, bring down costs, improve the quality of care, and expand access to coverage. Each category contained five specific proposals.

For example, under the first category, “Improve Mainers’ Health Status,” were these five choices:

. Encourage good food choices and increased exercise at school.

. Reward healthful behaviors with discounted insurance premiums.

. Enact tougher seat belt and helmet laws.

. Tax unhealthful products such as junk food and cigarettes.

. Require every health insurance policy to provide no-cost preventive care.

After a 10-minute debate – sometimes intense – with their tablemates, participants voted anonymously on these options, using electronic keypads. Their first choice was to encourage healthful foods and increase exercise at school, followed by requiring insurers to include no-cost preventive care in all policies.

But, using a one-per-table personal computer, participants also entered their own health improvement ideas. In a follow-up vote, one of these – the creation of a network of free public health clinics to provide primary and preventive care for all residents – emerged as the real front-runner in the category. An additional recommendation, to reduce cancer-causing chemicals in the environment, was adopted as well.

In the “Reduce Heath Care Costs” category, participants said the state should eliminate for-profit insurance companies, regulate all insurance premiums and cap the charges of insurers and health care providers. This category proved contentious and the votes were close; many participants argued that regulating, capping or eliminating corporate profits would cause insurers and providers to leave the state.

To “Improve Health Care Quality,” participants voted to control acquisition of expensive new medical technologies until they’re proved effective, to establish medical guidelines for doctors and other providers, and to develop a “report card” so consumers can see how well providers meet those guidelines.

In the category “Increase Access to Health Insurance Coverage” – which moderator Carolyn Lukensmeyer called “the macrolevel vote to change the system”- 48 percent of participants endorsed a single-payer health insurance system, while 30 percent voted to expand eligibility for Medicaid and the state’s DirigoChoice insurance plan.

Participants turned down mandated use of seat belts and motorcycle helmets as well as a proposal that would require people with mental illness to undergo treatment. They nixed mandated employer contributions to health insurance plans on the grounds that it would drive small companies out of business.

Votes from the focus group, along with comments from a planned series of statewide public forums on health care reform, will be used to guide development of Maine’s health plan, Riley said Sunday.

Lukensmeyer, director of America Speaks, the national group that organized and facilitated the event, said Sunday that she was pleased with the level of discourse in the Tough Choices debate.

“What I saw here yesterday was extremely sincere work on the part of the public to be engaged in this process,” she said. “It’s a sign of how broken our democracy is that some people came in very skeptical, wondering if it would it make any difference, if they would be listened to.” Despite some impassioned arguments and a few procedural glitches, she said, by the end of the day it was clear most of those in attendance felt their voices were being counted.

While Tough Choices participants showed agreement in many areas, she said, it’s apparent there’s more work to be done to fund the kind of health care system many of them envision.

Lukensmeyer said she regretted the low turnout that apparently resulted from the postponement of the original March date for the event. Organizers went to great lengths, she said, to find replacements without simply filling seats and losing the demographic spread. In the end, she said, the only real loss was to the number of “ambassadors to the next step” – participants who will carry the conversation back to their communities and work actively as advisers to the state health office.

One of those ambassadors is Steve Corriveau, a stocky 52-year-old millworker and the union local president at Lincoln Paper and Tissue. Corriveau spent Saturday listening to and debating with the opinions of a diverse group of concerned fellow Mainers seated at Table 14 at the Orono site.

“We’re in a health care crisis because of the cost – you don’t have to be a rocket scientist to know that,” he said in a brief conversation as the Tough Choices participants were disbanding for the day. One reason his company’s predecessor, Lincoln Pulp and Paper, went out of business last year was that it was paying more than $6 million annually to provide coverage to its employees – and that was just the employer’s share of the premiums.

“Employers can’t keep paying like that, and workers can’t either,” Corriveau said. Increasing competition for health care providers or insurers doesn’t seem to be the answer – “There just aren’t that many of them up this way.

“I guess we’ll just all have to take better care of ourselves,” Corriveau added. “One thing I learned today – there’s no easy fix.”

Detailed results of the Tough Choices for Health Care sessions in Biddeford and Orono will be available online Monday at www.dirigohealth.maine.gov and www.americaspeaks.org.