Childbirth always reminds me to give thanks that I don’t have the anatomy or the hips for that job. So it was no surprise to me one day several years ago that a laboring woman I was attending during her painful pushing process suddenly said, after a particularly painful contraction, “That’s it, I have had enough of this damn labor thing and I am out of here.” Now, women being women – usually tougher than Stonington granite when the going gets tough – and nature being irresistible, she bore down and finished the hard job.

The current state of debates in Maine about the Dirigo Health Plan and other measures to control health care costs reminds me of that patient. We have come down to counting how much money the Dirigo Plan has or has not saved, to hard restrictions on new hospital capital spending, to every remaining solution goring someone’s ox, and to many of the participants in the debates being sick and tired of working with each other because we all tick each other off no end. Some of us want out of here.

It does not matter. We are all stuck in this health care cost mess with no way out but through the hard work. We may feel like the maid Prissy of the movie classic “Gone With the Wind” telling Miss Scarlett, “Lawzy, we got to have a doctor! I don’t know nothin’ ’bout birthin’ babies!” Fear, reluctance and wishful thinking did not get Prissy out of the job, however, and will not work for us. If we want to deliver the baby of affordable health care in Maine there is no other way but to persist through the pain and the yucky stuff and “birth” the darn thing.

The sometimes reluctant midwives attending this delivery are Maine’s employers, doctors and other health care providers, hospitals, insurance companies, Gov. John Baldacci and his staff, a few influential lobbying groups such as the Consumers for Affordable Health Care, and all of us. Each one of us brings to the delivery room at least the following:

1. Legitimate ideas for controlling health care costs;

2. A genuine concern about rising health care costs, and a genuine concern about how those costs can continue to be borne by Maine’s people;

3. Legitimate areas of self-interest that to others in the debate appear largely self-serving;

4. Favorite ideas one constituency feels passionately are the solutions to the problem but that at least one other constituency thinks are the hare-brained products of hopelessly delusional minds;

5. Some behavior of each constituency that the others can point to as evidence that constituency either is not truly motivated by the interests of the patient and is not really interested in finding ways to control health care costs. The others can then use that behavior to disable any cost-cutting proposal made by that constituency.

For example, some health insurance companies say they are trying to hold down costs while at the same time paying top executives as though they were star basketball players. That makes those companies vulnerable to having any position they take in the debate dismissed because they are using a fortune in health insurance dollars to pay top brass. Or Gov. Baldacci will take positions on health care issues that are motivated in part by his need to use health care politics to get re-elected in 2006. That allows some to say he is only motivated by political considerations.

Many Maine hospitals are proposing new buildings, so others say hospitals are recklessly adding costs. Doctors could do more to improve the quality of their care and do fewer unnecessary procedures and tests, allowing some to suggest they are not doing their share. Patients could get healthier so they cost less, and give up the fantasy that they can have all of the health care they want and also have affordable health care. And on and on.

6. We all bring inadequate power to the table to unilaterally impose our favorite solution on all of the others in the room.

The effect is almost paralyzing; we can all block almost all of each other’s solutions, and all claim the high ground while doing so. It also means we can all say we are tired of this hard work and are out of here because the others don’t play fair. We can all say we are not birthin’ this baby, Miss Scarlett.

The reality, however, is that we are like the woman on the delivery table, stuck here with nowhere to go and no choice but to do the hard work ahead. Maine is a small, relatively poor state with health care costs rising at an unaffordable rate, and the federal government is not going to save us. We are either going to deliver this baby together or every Maine business that can afford to is probably going to leave the state. We are either going to get as much of the job done on a state level as can be done or employer-based health insurance in Maine is going to go the way of Maine’s shoe industry. We are either going to find answers or large parts of Maine will have few jobs, few doctors, no hospitals, no future and ultimately no people.

The failure of Maine’s principal health care cost-control players to continue slogging together toward every attainable cost-control measure is therefore not an option. We must all insist that no matter how much fatigue, frustration and bitterness there is over previous battles, none of it counts compared to what must be done. We must hold our doctors, hospitals, legislators, businesses, insurance companies, governors and ourselves accountable to bearing down and birthing this baby.

Miss Scarlett would be so proud.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.