DirigoChoice works for Maine

In February 2003, skeptical and angry as a hornet, I went to Augusta, ready to go head-to-head with anyone that dare suggest that anything was right or reasonable about the price of my health insurance doubling in two years. It was the first time I had done anything political beyond voting.

I had just had a stellar year in my little business. The increase in the price of health insurance I was buying for my employees and their families cost us more than the raise we all deserved. To pay the increase I had to lower wages, raise my prices and lay one person off. I got involved over more than the money.

I’ve spent these four years seriously studying our crisis in Maine. Too many people are suggesting that it’s all about the cost of insurance. Here’s what I’ve learned. My comments are my own and are not intended to represent any other individual or group.

Anyone talking about health care reform that doesn’t address the quality and overall cost of care should be ignored. Mainers spend 80 percent more on “complications from hospital care” than we do on “bad debt and charity care.” We needlessly have eight times more MRI machines than New Hampshire. Together, we already pay more than enough to provide high-quality health care to everyone in Maine – through premiums, and taxes, and through the price of everything from bread to Buicks.

I want the problem repaired – not just patched. I won’t settle for coverage that isn’t there when I need it, or for care that injures me. The price of insurance is only the tip of this iceberg. Health insurance is unaffordable because health care is unaffordable.

Health care isn’t a luxury item. It’s more like roads, schools, police, fire protection and countless other things we do together because we can’t do them alone. It’s barbaric that we don’t cover everyone. Our crisis is a matter of conscience; our conscience. We can solve this thing. I’m not certain that we will.

The Institute of Medicine is the most authoritative nonpolitical voice in American medicine. In their 2001 report “Crossing the Quality Chasm” they say that America’s health care is too often inefficient, unsafe, ineffective, untimely, inequitable, and too seldom centered on the well-being of the patient. The most expensive and technologically advanced system of health care on Earth ranks no better than 24th in overall performance while failing to cover 41 (now 46) million of its citizens. They found that these disturbing facts are intimately related and must be addressed together.

We began applying the insights of “Crossing the Quality Chasm” to Maine in 2003. The then new Gov. John Baldacci brought together virtually all the players in Maine’s health care system – including regular people like me. The result is the work-in-progress called the Dirigo Health Reform. It became law with overwhelming bipartisan support.

Everyone supports the parts of Dirigo that don’t require them to change. Rooted in our desire to provide affordable high-quality health care to every citizen, Maine’s health care system will take the form our expectations allow. One powerful thing every person can do is to imagine health care as it should be … and expect it. This may sound weak and unimportant, but – from the Institute of Medicine’s perspective – it’s as powerful and practical as blood pressure.

The Dirigo Health Reform established the Maine Quality Forum to address quality. The Forum examines and recommends standards for care, new technologies – including electronic medical records – and means of engaging Maine’s communities in healthful behaviors. It publishes newsletters and a growing web site dedicated to safe, timely, effective, efficient, equitable and patient-centered care. It also supports and amplifies other quality improvement initiatives in Maine.

Dirigo established a comprehensive State Health Plan, examined the business practices of our hospitals and insurers, and studied new advances in VA hospitals. If you believe that insurance is too costly, voice your support for the Dirigo Health Reform.

Dirigo established the most successful start-up health insurance in Maine’s history. Called Dirigo Choice, it offers a benefits package found nowhere else. It’s priced according to one’s ability to pay. It is – by design – the best health insurance value in Maine. It currently covers over 18,000 Mainers from Kittery-to-Calais-to-Fort Kent. If it’s yet too expensive for you, voice your support for the Dirigo Health Reform.

The Dirigo reform stiffened insurance regulations to further ensure that the coverage we pay for is there when we need it. All of Maine’s insurance regulations – combined – account for a maximum of only three-and-a-half percent of the price of insurance to an individual and 8.5 percent to those in the largest groups. Dumping regulations would not lower the cost of care, and would expose everyone – except insurers – to unacceptable risk.

The effect in 2004 of the combined reforms of Dirigo health was savings in health care costs of forty-three Million seven-hundred Thousand dollars. This is much less than one percent of the total public and private dollars Maine spent on health care in 2004. The savings are additional monies – already paid in premiums – above actual costs and normal profit.

Dirigo also established a fair means of capturing these savings to support discounts to low and middle income people. Insurers are attempting to charge Mainers for the refund. That is like paying someone at the grocery store to return your change: it is simply wrong.

Our health care crisis is one disease with three symptoms. Our problems with the cost of care, the quality of care, and access to care challenge our assumptions about what Care is, who, when, where and how to deliver it, to whom, and how to pay for it. Lack of will and ambition to face this challenge is the disease at the core of Our crisis.

The symptoms have taken many years to develop. They won’t change quickly. We must treat the disease or the symptoms will worsen. The Dirigo Health Reform is the right medicine. Its guiding light is what health care means to patients. It’s two-thirds not about insurance … because it must be.

John Baldacci has demonstrated real leadership, courage and foresight in putting the Dirigo Health Reform on the table – and in protecting it. It is the value of our money – and of our health – that is inside the political football that others have made of Dirigo.

I’ve spent many days writing this. I worried that whatever I say might be disregarded as merely political. The best Economic Stimulus Package I can imagine is to solve our health care crisis. The most we can do for ourselves and for our communities is to solve our health care crisis. These things make health care political. What health care should be – over our money … and our politics – is what moves me.

David A. White (importedcarsvc@acadia.net) is a member of the Maine Quality Forum Advisory Counsel. He buys DirigoChoice for himself, his employees and their families. He is a Small Business Member of the Maine People’s Alliance.