No one asked me to design a state health plan for Maine, but if they had I would have suggested we all just retire immediately to Florida. Then Maine’s problem of having to pay for health care for a generally older, sicker and poorer population than many other states in the country would be solved with a few south-bound bus convoys.

It seems unlikely that Maine Gov. John Baldacci will endorse my state health plan, especially now that he knows what it is. We are therefore stuck with his Maine state health plan, a draft of which was released recently (available on the Web at www.dirigohealth.maine.gov). His plan is a pretty good starting point, and Maine ought to start implementing the parts we agree on while we fight over some of its details. Time, money, and lives are a’wastin’.

Much of the unhappy noise about the plan has been from core constituencies unhappy about some of what it includes, or about things the plan does not include but should have, and they have some legitimate beefs. Doctors and hospitals, for example, are unhappy because it does nothing to address the state’s growing Medicaid budget deficit, a hole in the plan through which the Baldacci administration continues to hemorrhage cash and credibility.

I wish it specifically proposed mandatory motorcycle helmets, primary seat belt use enforcement, malpractice reform through the promotion of evidence-based medical practice guidelines. It needs more short-term cost- control measures, and says little about the need to ration health care if we are to control costs in the short term.

The plan does not delineate a philosophy of financial incentives (other than reduced health care costs) for individuals, businesses, and communities to improve health. And it says nothing about having the governor regularly hot wax my car.

In its own words, however, the plan is “a roadmap,” and not a destination. I like to think of it as underwear and not a suit; it gets us started, but we are not yet dressed for the prom.

Real credit should be given to the Baldacci administration for putting a plan on the table for the rest of us to carve up. In fact, what is most important in first versions of big plans is not perfection but that someone has the guts and will to finally develop one as the work in progress big, groundbreaking plans are always meant to be.

Trying to design a state health plan is like trying to train a pen full of pigs to walk a tightrope; it is a long-term, arduous process involving smelly work, squeals of protest from reluctant participants and a lot of falls to the net. Few governors anywhere in the United States have put together comprehensive state health plans, despite the chaos of our health care system.

In the next year, instead of carping to the ringmaster who got the pigs onto the high wire that we want our money back because the pigs cannot fly, we should be focusing on implementation of those elements of the Maine state health plan on which we can agree.

For example, the plan appropriately calls for Maine to set the goal of becoming one of the healthiest states in America. Not only is that a goal which bodes well for our own health and longevity, but Maine cannot afford anything less; it is too poor not to be the healthiest state. If Maine’s government, health care industry, health insurance and business leaders stood up together and publicly embraced that goal, and then took a few, serious steps toward it in concert, the effects might crystallize the effort to substantially improve the health of Maine’s people. And I would eat a pair of my Fruit of the Looms in celebration.

The plan calls on each of us to sign a “Contract for Better Health” with our doctors or some other individual, a contract in which we each pledge to abide by a personal plan to improve and maintain our health through diet, exercise, preventive health measures, etc. If we all signed such contracts and kept to the terms, the results could be rapid improvements in individual health and rapid, significant reductions in health care costs.

If the same leadership dedicated itself to achieving that goal we might just be able to make it happen.

The state health plan calls for a better public health system, and reductions in the numbers of Maine teens who smoke, drink, have undiagnosed depression, and are without health insurance. These are all achievable goals. It calls for all Mainers to have access to affordable health care, which they might if we all quit wasting money on preventable illness.

The Maine state health plan is not a simple collection of pipe dreams, either. The seemingly dreamy goals of improving the health status of Maine’s people, and thereby reining in health care costs to affordable levels, are achievable. Those who disagree with the goals, or despair at the work necessary, should remember other lofty goals that have been achieved here.

Twenty years ago, Maine had the apparent pipe dream of ending its lethal status as the state with the highest rate of infant mortality in the country; it now has among the lowest infant mortality rates in the country. It has dramatically reduced smoking among adolescents, a simple change that means a lifetime of better, less costly health for the smoke-free.

Thirty-five years ago a doctor in Franklin County named Burgess Record had the pipe dream of ending his county’s ownership of the highest mortality rate in Maine from preventable disease. It now has among the lowest, and if Maine had the same mortality rate from 1970 to 1994 that Franklin County does now about 18,000 fewer Mainers would have not died early from preventable diseases. Real lives, and money saved are the stuff of such dreams.

As we all peer through the entrails of the draft Maine state health plan we should do a few things before we simply point out the obvious, that it is the ugliest pair of underwear since those red long johns Grandpa used to wear. First, remember it is a place to start, and without a place to start we will continue to simply follow the current plan, which is to be sucked down the financial rat hole by rapidly rising health care costs. Second, you can carp about the plan’s deficiencies, but if you don’t contribute more than that you develop up with your own comprehensive state health plan, then try selling it. Better yet, work with the rest of us across the high wire of tough issues to make the current plan better.

And finally, if you are not working every darn day to improve your own health by exercising for more than 30 minutes at least five times a week, getting your weight to where it should be, wearing your seat belt, giving up the smokes, taking your medicines as directed, etc., then consider holding your criticism of the draft Maine state health plan while you work on your personal health plan. Otherwise, you may have a lot to say about the new draft state health plan, and a lot of it may be valid, but I am going to have a hard time taking you seriously until you at least put on your underwear.

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.