The health care crisis is not fun, easy or inviting to consider. It’s huge, complex and ugly. The high number of uninsured, obscene profits and tragic outcomes are symptoms of fundamental problems. We can no longer ignore it. It has no simple solution. It won’t change quickly. The good news is that Maine has begun to address the problem. The initiative is called the Dirigo health system reform plan. Mainers have reason to be proud and hopeful.

The crisis is huge. Health care is now America’s largest industry. It consumes 1.5 trillion (that’s 1.5 million-million) dollars a year. We spend twice as much per person on health care than the average spent by all other industrialized nations. We spend 32 percent more than Switzerland, the second most costly nation. Yet we rank only 37th in the world for overall system performance.

All of the citizens of the major industrialized countries are covered. Our system leaves more than 43 million people uninsured (about 140,000 in Maine). We also leave another 78 million Americans (about 200,000 Mainers) underinsured with unaffordable deductibles. More than 90 percent of the uninsured and underinsured are working people. As their numbers increase charity care increases, further driving up costs for the remaining insured. Our work force is growing less healthy, less secure and less productive. Our “system” is a scandal. We don’t need more money for health care, we need more health care for our money.

The crisis is complex. It would be easier to solve this puzzle if it were only about money. But there are two related fundamental problems that plague us. One is that we treat health care like a privilege. The other is that our health care system is not patient-centered. It would be equitable and less expensive to insure everyone – we’re already paying for them. And establishing a patient-centered system would increase its safety, effectiveness and efficiency while also saving money.

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Many people are angry that their health care system is not equitable or patient-centered. They’re frustrated by its apparent immunity from “blame” and reasonable constraint. To crack this nut requires a type of “systems” thinking that most are unaccustomed to. Curiously, imagining an equitable and patient-centered system is the “key” to making it a reality. Nonetheless, the system won’t change quickly, and it will crash if we don’t begin in earnest very soon.

The crisis is ugly. Two of the top 10 causes of death in America are lack of sufficient insurance and medical errors. Lack of sufficient insurance affects lives by failing to provide adequate care, and by forcing folks to delay care until their condition is chronic. It’s also the leading cause of bankruptcy. Medical errors are so common that they’ve become more the rule than the exception. They cause up to 98,000 deaths each year.

But don’t go “blaming” your doctor or hospital. Most tragic incidents occur from the “alignment” of many separate errors rather than from single gross mistakes. The present system is based on a caregiver-centered model. It worked reasonably well when medicine was simple and doctors were the whole ball of wax. But as new drugs, specialties, technologies and complex hospital environments emerged the old model became stressed, pushing patients further from its center. The various parts of the system don’t communicate well with each other, even when they’re in the same building.

This obviously compromises the efficiency and effectiveness of care, patient safety and costs. Rewarding a patient-centered system will encourage the necessary changes.

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Here’s the good news: Dirigo Health has begun to address Maine’s entire health care system. Most people think Dirigo is only about insurance. While it will offer the best value in health care, and regulate small group health insurance rates, four-fifths of Dirigo addresses the root causes of Maine’s health care crisis. Five different unpaid commissions composed of virtually every stakeholder, and working together with Maine’s entire health care system, have begun to address the issues of patient safety, system effectiveness and efficiency, and the cost of care.

Among Dirigo’s initiatives are a collaborative approach to the development of a state health plan, the institution of quality measures and best practices, prevention and wellness education, measurement and public disclosure of reports on quality, and the establishment of patient-centeredness throughout our health care system. It won’t change easily or quickly. We’re in this together and we’re at the beginning.

We have good reason to be proud and hopeful of the courage, Yankee ingenuity and initiative that guide the Dirigo health system reform plan.

David A. White owns MDI Imported Car Service in Town Hill. He represents the Maine People’s Alliance 1,400-member small business group. His e-mail address is importedcarsvc@acadia.net