Most Maine business people believe that significant changes will occur in our health-care delivery system in the coming months and years. For the most part, they welcome these changes. If the Maine Chamber of Commerce and Industry’s Board of Directors is any indication, however, most business leaders adamantly oppose destroying the system which provides the world’s highest quality health care when less sweeping changes will correct deficiencies.

The U.S. health-care system has two fundamental flaws. First, although everyone can get health care whether or not they are insured, those without health insurance must get it in hospital emergency rooms. This is costly and inefficient. In addition, care is often too late to prevent a medical condition from worsening.

Second, health-care costs are rising much more quickly than our ability to pay for them. Unless costs are controlled, more and more employees and their employers will find it impossible to pay the premiums.

The Maine Chamber of Commerce and Industry board has carefully considered the idea of a single-payer Canadian-style system where the government runs the system and pays the bills. We believe such a system to be unnecessary and potentially very expensive. It “fixes” things which aren’t broken. Business leaders are also fearful about state or federal governments that have had great difficulty managing their finances, pension plans, and Medicare and Medicaid programs, getting into the health-care business.

The problems of providing universal access to basic care and cost control are serious. However, most business people think they can be fixed without “throwing the baby out with the bath water.” It is here that we part company with many health-care reformers. The Maine Chamber supports the concept of expanding coverage through our current health-care system where most people get coverage through their employer but with employee contributions bearing some of the cost. The government should play a more active roll in providing basic care for those not employed who cannot provide insurance for themselves. This would solve the first problem by providing universal coverage.

The second problem, the need for cost controls, will require a number of tools to solve. Among those supported by business are managed care where patients are directed to appropriate care by their family doctors, having patients pay for part of their care through co-payments and deductibles, a more rational system of distributing high-tech equipment and services, managed competition, legal reform which would reduce lawsuits and the amount of health dollars being spent on lawyers and defensive medicine, and expanded research on identifying the most cost-effective treatment for each ailment. It will also be necessary to limit what a universal system will pay for and to make certain that everyone contributes something to the cost of their coverage. If these don’t work, more intrusive methods may be necessary.

Finally, Maine business people have three important prerequisites which must precede adoption of any universal system in Maine. First, nothing should be done until the Clinton administration and Congress adopt the framework for reform at the federal level. Second, no Maine system should be adopted until the costs are carefully analyzed and we are confident of the numbers. Finally, no system should be enacted without a careful analysis of the burden on Maine employers, emplyees, and taxpayers and on the competitiveness of Maine industry.

Jack Dexter is the president of the Maine Chamber of Commerce and Industry.