Even as Superior Court Justice Roland Cole last week supported the ability of the Dirigo Health Agency to set insurance-industry payments for the program, a state blue-ribbon commission was looking for a new system of revenues that would avoid the controversy caused by that payment. The panel certainly could find other ways to raise the funds, but if it is to keep the underlying point of Dirigo, it must include money recaptured through increased efficiency in health care.

First, it is important to note that the groups that sued Maine argued that the law creating the Dirigo Health Act was unconstitutional. They also charged that Dirigo’s savings of $43.7 million, achieved through hospital savings and, to a lesser extent, reductions in bad debt and charity care, was inappropriately determined, and that the evidence did not support the approval by the superintendent of insurance of these savings. Wrong on all three points, according to Justice Cole, giving Dirigo much firmer ground on which to proceed.

But how should it? Politically, opponents of the Baldacci administration have taken this relatively modest program with a universally accepted goal of expanding affordable health care and whacked the governor over the head with it for three years. The blue-ribbon commission to review the savings payment, which the insurance industry hates, was one result of this.

The commission, which is due to report its findings by Dec. 15, may feel pressure to de-link the payment for Dirigo and the identified savings it seeks to measure in health care. For instance, one suggestion would simply put a fee on insurance premiums to fund Dirigo and hope the savings through efficiency were achieved out of self-interest by the industry. This would be a major mistake.

To the degree Dirigo has value, it is in recognizing the high cost of health care and asserting that by looking at the system as a whole, Maine can provide coverage to the underinsured and uninsured without additional money and without sacrificing the quality of care. That is its bold and important message; take out the savings and, with one possible exception, the incentive for efficiency reverts to the status quo.

The exception is in setting rates. If it is true, as insurers have said, that they have limited influence in negotiating lower rates with medical providers, one answer is for Maine to do what the federal government does through, for instance, Medicare. It says how much a procedure or a treatment or a pill is worth and that’s the price. Maine had a rate setting board previously and it had much lower health-care costs compared with other states than it does now.

There’s nothing simple about setting rates, and to be accurate, it demands transparency of health-care costs – an ability for regulators to see where the costs are created and what the proper price ought to be. Maine has new transparency rules going into place this year, but even more would be necessary.

Whatever system the commission eventually chooses, its abiding standard ought to be whether its choice produces a more cost-effective system for Maine, with tangible results and improved access for all Maine citizens.