Second of two parts

As explained in Part 1 of this commentary on the NEWS weekend Op-ed page, a Community Health and Trust Fund of Maine Saturday and Sunday could grow through a recapitalized and remade Blue Cross and Blue Shield of Maine. Such a change would have major advantages for CHTM stakeholders.

Purchasers would benefit from CHTM because it would offer them substantially greater predictability about and control over premium rates. There would be no surprises, no dramatic price fluctuations in premium levels at the end of the underwriting cycle. They would have greater confidence in the value of the services being purchased because the quality and reliability of research data would be greater than anything available today. Artifacts in the pricing of health services, especially around specialty care, would be eliminated.

Government would benefit because CHTM offers a creative approach to better enfranchise the Medicaid population without creating a new bureaucracy. The provider-equivalent of “the two Maines” — yes, it’s at play for doctors and hospitals too — would be dissolved.

Maine’s providers would have a say in the operation of the corporation, would retain control of clinical-decision making and would receive fair compensation and prompt payment for their services.

Residents would have a wider choice of and greater access to health-care providers. Health insurance options would be more numerous and more affordable than is possible right now. In addition, no other state in the nation could boast having both quasi-public worker’s comp and health insurance corporations, thereby giving Maine extraordinary powerful instruments for targeting high quality, well considered economic growth. Effective economic development means more high-paying jobs, a more flexible and resilient economy, more Mainers with good health insurance and a broader tax base.

All of us — purchasers, providers and patients — would have a sense of ownership of and commitment to CHTM’s processes and products. The health-care environment in Maine would be at once more stable and vibrant; more humane and disciplined; more affordable and equitable.

Maine residents have been surprisingly quiet in the face of the expected purchase of their Blue Cross and Blue Shield company by Indiana-based Anthem. Perhaps this apparent lack of concern arises because the public feels distant from and uncomprehending of the health insurance world. Perhaps it is because we have grown accustomed to seeing so many familiar businesses lose or at least substantially alter their Maine roots, sometimes disappearing completely from the state’s economic and social landscape.

Perhaps it is because the public believes that the creation of a charitable foundation, a required byproduct of the acquisition of the nonprofit Blue Cross by for-profit Anthem, will fully compensate Maine for its loss. But let’s apply this same logic to another, more accessible if fanciful transaction. Suppose for a moment that the Baxter State Park Authority were to announce plans to sell Gov. Percival Baxter’s legacy including Mt. Katahdin, the essential and enduring landmark of Maine, to the good people of Indiana. Why not? After all, Maine could use the infusion of capital to improve its public infrastructure (think of this as a downpayment on the east-west roadway proposition).

Hoosier State residents — for whom mountains and clean surface water are novelties — might be willing to put up $120 million (the amount Anthem has offered to acquire BCBSM) to add a little elevation and pristine water from Maine to their own otherwise uninteresting terrain and turbid lakes and streams. Imagine Baxter Park Authority officials deflecting criticism with: “Hey, the park will still be here, even if Maine no longer wants it. Sure, Indiana will now set the fees, determine the land use, hire the staff and control access to the park. But don’t worry, officials from Indianapolis have assured us that they won’t be making any substantive changes to Baxter — even after paying the $120 million. Besides, we would set up a charitable foundation from proceeds of the sale of Baxter to Indiana so that more Mainers could use our other state parks…”

Wouldn’t Maine’s citizens find this arrangement odd, even disturbing? Would we speak out?

Whatever the basis for the deafening silence, the proposed acquisition of Blue Cross will not be good for Maine patients, those who pay premiums or the doctors, hospitals and other providers who care for Maine residents. As a general rule — MBNA appearing to be a notable exception — out-of-state ownership is less likely to produce the level of commitment to civic duty and community life than companies whose owners reside in Maine, who share our traditions (and our winters), whose children attend Maine schools, who have a stake in the quality of life and vitality of the towns in which they reside.

While the sale or transfer of Maine-based businesses may be good for shareholders, they seldom benefit employees or communities. These principles, I submit, are just as pertinent to health insurance as they are to any other sector of our economy.

Maine has been a leader in so many areas — conservation of resources/recycling, enviromental protection practices, a statewide EMS/trauma care system, smoke-free public venues, vocational/technical education, school reforms, prenatal care, reducing unintended pregnancies among teens. Why, then, should it be a passive observer of bad trends and ill omens in health insurance?

If the admittedly ludicrous example of the “proposed” sale of Baxter State Park to the State of Indiana would move us to act, what are we waiting for in the very real case of selling Blue Cross/Blue Shield of Maine to Anthem? If ever there were a time for our state motto, Dirigo (“I Lead”), to be brough decisively to bear to benefit present and future generations of Maine people, this is it.

If ever there were an opportunity for this governor and this Legislature to confer upon Maine residents a legacy as far reaching, lasting and dramatic as the creation of Baxter State Park decades ago, the transformation of Blue Cross and Blue Shield of Maine (BCBSM) into the Community Health Trust of Maine (CHTM) is it.

Bruce D. Cummings is chief executive officer at Blue Hill Memorial Hospital.