Health-coverage failure along the way

The imperfect beginnings of John Baldacci’s DirigoChoice health insurance and George Bush’s Medicare drug benefit – confusion, under-enrollment, cost questions and, naturally, lawsuits – provoke more or less the same response. Health care reform is complicated; these reforms will take time. I’ve said this myself. But that’s only about a quarter of an answer. Why do they need time? To fail, of course.

By failing – or if that’s too strong, let’s say stumbling – they expose the idiocies of the current system, which in one way or another the Maine and Washington reforms reinforce. It is a system larded with private-enterprise bureaucracy, high prices, expensive underwriting, uneven service and a perverse insistence on treating your health care as if it were a commodity, like a plush toy or a can of soda.

DirigoChoice is a multi-layered public plan with, possibly, many sources of funding, but for now its subsidies are relying on health care savings passed through insurance companies, which the companies insist they cannot find. It should be said that nearly everyone admires Dirigo beyond its insurance product – its quality forum, certificate-of-need process, state health plan. Medicare Part D, on the other hand, has less to like. It’s a confusing assemblage of multiple private plans that may or may not cover the drugs seniors need but will certainly enrich the insurers through another interesting source of funds: your taxes. Or maybe your children’s taxes – there’s a lot of deficit spending going on these days.

Whether the inadequacies of the way we pay for health care are exposed through the public Dirigo or the private Part D doesn’t matter. They’re both paths up the same mountain, at the top of which you will find seniors, the poor, veterans, more than a third of the nation that receives government-run single-payer health care coverage. Just like much of the rest of the industrialized world, which for 40 years has offered models that cost half as much as our national dysfunction and offer more care.

Federal and state governments provide public coverage because health care, in the expensive forms that matter to the debate over cost, is not a can of soda, in which a consumer decides how much and what brand to buy. Kidney failure is not a shopping opportunity. Health care – does this need to be said? – is an essential part of a civilized society, and denying health coverage to a sizable portion of the population (45 million and growing) while the major actors fight over the trillions of dollars at play is, if nothing else, an uncivilized and wasteful embarrassment.

But before the nation reaches the point of admitting that a combination of public financing and private service (just like the charter schools conservatives love) really does work, there will be a lot of noise about small reforms. There will be health savings accounts, for instance, in a country with a zero savings rate and employers trying to limit benefits. Or association health plans, which let certain businesses avoid state mandates that don’t add up to as much as critics say. Or requirements that everyone carry health insurance as they do auto insurance, which won’t keep health care costs from growing at 12 or 14 percent a year.

Legislative Republicans this week mentioned these ideas and several others, pointing to states that have lower prices for coverage. They did not mention that these states have increased their number of uninsured while Maine’s total has fallen. Nationally, between 2000 and 2004, the number of Americans in employer-sponsored plans dropped by nearly 6 million. Medicaid expanded by even more and picked up many of those while its opponents explained why public financing cannot work.

Whether Maine dumps its sick into high-risk pools or spends its time fighting over how to fund Dirigo, the underlying problems of rising prices and an inefficient payment system remain.

Maine and the nation can continue the way they’re going – forcing businesses to decide among expensive insurance, inadequate affordable coverage or none at all for employees. They can continue to expand public coverage piecemeal, and they can watch costs rise and care be further rationed. They can skirmish over every minor change.

Or they can think bigger, about something ambitious and compassionate.

Can a small state create a coherent, efficient plan with universal coverage that doesn’t drive out the medical community? It can if it begins with recognizing the burdens on those professions: the hassle of evermore paperwork and approvals to treat patients, progressively eroding incomes, the threat of catastrophic lawsuits and more.

It would help if everyone involved, employers especially, faced just how thoroughly the high cost of the current system affects everything else. And though Republicans explaining health care is a lot like Democrats trying to describe economic development, their market ideas are important to creating an efficient reform, even if they do find public financing distasteful.

Who knows? If a real remake works in Maine, perhaps Washington could copy it and Medicare Part D will be remembered not as a failed attempt at privatization, but part of the inspiration for finally fixing health care.

Todd Benoit is the editorial page editor of the Bangor Daily News.