NEW PATH FOR DIRIGO

DirigoChoice, the Baldacci administration’s health-coverage plan, was fought over all legislative session, mostly over two bills. The first, after several amendments, would have limited enrollments in the plan by cutting the plan’s funding, among other things. The second would have expanded the state’s involvement with coverage by allowing it to self-fund coverage.

Both bills failed, but that doesn’t suggest satisfaction with the status quo. Instead, it indicates confusion from a Legislature that has neither the leadership nor the votes to move Dirigo in any direction.

In response, Gov. Baldacci last week signed an executive order creating a commission to make recommendations to figure out long-term funding and ways to save money within health care. That’s a fine idea, and the order is broad enough to include a range of possible outcomes. But the outcome that matters is the one that keeps getting lost in the politics: universal access to high-quality coverage, brought about by greater efficiencies in care and in coverage and through the expansion of subsidies for those with moderate incomes.

This is not a Democratic idea or a Republican idea, but it quickly devolves into a partisan contest once the specifics of the policies are brought forward. Though the result is often entertaining, it is also a huge waste of time, so when the governor appoints his commission he should have a litmus test: the standard is support for universal access within a fairly brief time – six or eight years – without quality of care being compromised.

In fact, through the Maine Quality Forum, another part of Dirigo, it should be improved. The governor should define at the outset what he means by coverage, then be certain to invite a wide range of political opinion to the commission.

For instance, much of the Dirigo debate over the last year has turned on the “savings offset payment,” the money Dirigo is said to be saving health care providers, to be passed back through insurers to the state, which would use the money to provide more care. For last year, the superintendent of insurance agreed that the amount of the savings offset payment was $43.7 million. Insurers do not want to pay this money or any amount of the SOP, which is complicated enough to provide plenty of ways for the insurers to fight it annually.

Maine state government could accept this position and move on. The Baldacci administration would profitably look at what presidential administrations have done for 40 years under Medicare – set the price for the service and reap the efficiency going in rather than trying to collect it after the fact, as the SOP does. Medicare has an extensive set of payment schedules already in place; they may not be exactly right in Maine, but they are a solid base on which to build.

Set prices direct more money to care rather than to underwriting, leave insurers to compete on service and, most important, provide more affordable coverage to everyone. It would work with the kind of play-or-pay model recently adopted by Massachusetts, only it would be more likely to restrain costs.

However the commission interprets its charge, it will be judged by how clearly it moves Maine toward broadly accepted goals of universal access and high-quality care. After a legislative session full of long and confusing political maneuvers that moved the issue not at all, Dirigo needs strong support and a renewed sense of direction.