A DIRIGO SOLUTION

The fight over Gov. John Baldacci’s DirigoChoice health coverage has come down to a debate over who pays for the subsidies in the plan. At stake is the coverage for 14,000 individuals and 2,000 small businesses and the future of the program itself. But so far, neither the program’s supporters nor the industries aligned against the payment plan have provided an adequate payment solution.

Dirigo supporters say simply that the money – $43.7 million through what is called the savings offset payment (SOP) – must not come from taxpayers. This is entirely sensible given that the superintendent of insurance agreed the $43.7 million last year was savings reasonably attributed to Dirigo. But it is also the case that the mix of savings, mostly through voluntary hospital spending restraint, is not what Dirigo promised. Nor has it delivered on the federal Medicaid money it said it would produce.

Last Thursday, the Maine Association of Health Plans, Maine Hospital Association and Maine State Chamber of Commerce proposed an alternative to the SOP. Actually, two plans – one short-term that would have the state expand Medicaid through general-

fund dollars rather than through the SOP and cut Dirigo agency expenses, among other things to pay this year’s bill. Second, it proposes a long-term plan that would form a commission to re-evaluate Dirigo enrollment, impact on private payers and funding sources, among much else.

The second half, the commission, is fine if it also includes a requirement that commission members devise a new way to look at measuring savings, perhaps bringing in a neutral party. That is important going forward because it would keep Dirigo close to its original intent – to help pay for itself through removing waste from the health care system. (So why doesn’t Maine do what many large businesses do and save further by self-funding?)

But a new savings measure is also crucial for solving the current standoff. A compromise would look like this: Insurers pay the current SOP without passing the cost on to ratepayers. They take part in devising the new measures, then apply them to the past year’s numbers. If the $43.7 million holds up, nothing changes. If insurers are correct and that number is smaller, the state would be responsible for paying back the difference to insurers. If the savings are greater than $43.7 million, insurers would keep the difference for that one year only.

Study after study shows that Americans pay more for less health care than any other developed nation, and Maine pays more than almost any other state, though it is too rarely noted that Maine also has one of the lowest uninsured rates in the country. There are savings in the system; how much has yet to be determined, and Dirigo may someday reach a point where getting any added savings comes at too dear a price.

But Maine isn’t close to that point yet, so for now it should focus on pulling the waste out of health care. It can do that by coming to agreement on how savings are calculated and examining past and ongoing savings without the conflict that has characterized the debate so far.