Maine Insurance Superintendent Alessandro Iuppa recently proposed changes to health care coverage that would allow insurers to charge higher prices to the sick and lower prices to the healthy; charge higher prices to those with unhealthy lifestyle choices or in dangerous occupations; drop individual plans; and largely drop standardized plans.

If his proposals work, they will attract more competition to Maine, expand the number of people insured and lower health care costs for most. If they do not work, they will cut off the most needy from insurance, leave people few options but to buy into inadequate health plans and limit access to health care, thereby worsening illnesses or, perhaps, hastening death for the uninsured or underinsured. That is what is at stake here and across the country as health care continues to be treated like a product no different from CD players or skateboards – nice things to have if the market can produce the item cheaply enough.

When Maine’s director of consumer health issues at the Insurance Bureau quit last month, she did so with a warning. Alice E. Knapp said the current direction of government health care policy would cause “a steady erosion of health plan benefits combined with higher co-pays and deductibles.”

This, she wrote, “will ultimately represent a massive cost shift to consumers that will make the impact of the increase in oil prices on low- and middle-income families pale in comparison.” The superintendent’s attempt to expand the number of people insured and allow new types of coverage is rational only within the current irrational system of steeply rising prices that imperils all but the largest insurers and forces businesses to make uncomfortable choices about employee benefits. If Maine wants to create a more rational system, then it wants to increase, not reduce, community ratings that more evenly spread out the cost of health care, even as it offers incentives for residents to choose healthier lifestyles. It wants also to ensure consumers can compare products through standard or basic insurance packages and not be left with no choice but to accept insurance that doesn’t kick in until a deductible hits bankruptcy levels.

The problem of the uninsured and the possibility that Congress might do something about it next year recently got insurers, consumer groups and hospitals to agree to a huge expansion of Medicaid, essentially to cover everyone under 200 percent of poverty, an estimated 23 million people. It would also provide tax credits so low-income workers could afford employee insurance coverage and credits to some businesses that opt to pay the full premium on a low-income employee. If such a plan were to pass, it might well take care of the problem identified by Superintendent Iuppa, without some of the risks involved in his plan.

At the very least, Maine should see where this latest national plan is going before making significant changes of its own. It’s almost too much to expect that Congress will take on the issue of health care in any comprehensive way, but in the absence of action, the costs Ms. Knapp refers to show up in unexpected ways, including in plans by the state’s own insurance superintendent.