Editorial: Time to consider universal health care in Maine

Posted Wednesday, May 18, 2011 in Opinion

The United States has 47 million people - more than 15 percent of the population - medically uninsured and still, per capita, pays almost $8000 per year for health care.  That's nearly double what the next most expensive country pays.

Maine's uninsured population was much lower in 2010 than the national average.  Only 10.3 percent of Mainers were uninsured, mostly young adults.  But with MaineCare changes, that figure is likely to approach the national average.

Clearly, there are a lot of things we could be doing differently. One of the fastest growing cost centers is prescription drug coverage, and it is long past time to do what nearly every other Western country in the world does - set price limits for prescription drug prices.  One of the reasons why Canada's per capita cost is only half of the U.S. cost is that Canada does set limits on prescription drug prices.  Another reason is universal coverage.

The Republicans have made hay by decrying 'free health care', but universal health care in countries with a single payer system is not free - it is simply administered through the government, and paid for in part through payroll deductions by workers or employers for themselves and their dependents, and in part through general taxes. The unemployed or disabled or the elderly or those on general assistance are paid for by the provinces through a special insurance program  that pays for health care for these vulnerable populations. The vast majority of people who live in a nation with single payer universal health care like it a lot - in Canada, 91 percent have a high opinion of their health care system, while a similar number have a low opinion of the U.S. system.

The same cannot be said of the reverse.  A poll taken about a year ago - after the health care reform brouhaha - still showed that more than 70% of Americans wanted a single payer universal health care system like Canada's, rather than the mishmash we have in the U.S.

One of the major reasons businesses cite for not locating in Maine is the high cost of health care.  Despite the recently signed health insurance overhaul, most of the state's residents will likely pay more for their insurance - the average age of Mainers is 47, and the bill allows for much higher insurance costs for people 48 and over.  In addition, places where jobs are desperately needed - northern Maine, Down East, and in the western mountains - are going to be hit with higher fees because of their geography. 

So while there will be changes, they are not likely to spur job growth in places, and among the populations, who need jobs the most.

However, Maine has some unique advantages that a wise legislature could turn to its advantage, creating an affordable, universal system in Maine almost overnight.

Most of Maine's hospitals belong to one of three large hospital networks, based on regions for the most part.  Most doctors belong to one or more of these networks - some 85 percent. The rest could join one, and other providers (alternative health care, etc.) could sign affiliation agreements.

Then, businesses could sign up to become members of the hospital network, and their employees could visit the hospital, the affiliated doctors and other practitioners at a low point-of-service cost, instead of paying an insurance company at all.  Right off the top, health care costs would fall by between 20-30 percent.

For instance, let's assume company A, with eight employees and dependents, joins MaineHealth, a large network of 16 hospitals and laboratory providers in southern and midcoast Maine.  Let's say that the insurance cost is split between employer and employee evenly, and that monthly membership costs $200 per person.  The cost for the employer then is a known, predictable, $800 per month, and each employee pays half his family's cost.

Now, $200 per month may seem unreasonable, but a check of Kaiser Permanente's (a similar approach to the one outlined here) invididual rates shows that health insurance in California can be obtained at this rate - or less.  Medi-Cal - the California equivalent of MaineCare - offers Kaiser as one of its preferred options. So does Medicare.  Kaiser routinely makes millions in profits each quarter.  While Maine's hospital networks are nonprofit, the savings that can be earned by a Kaiser-like approach can help to cover the costs of health care for not only the uninsured, but also for Maine's aging population.

Let's further say that any MaineCare patient or unemployed person is automatically enrolled in MaineHealth if they live in one of the MaineHealth regions.  There would be a fee for each patient, not per service.  So if it costs $200 per month to belong, and each person uses the doctors, pharmacies, and other providers in the network for a point-of-service fee of $10, doctors would be encouraged to keep costs down, not perform unnecessary or repeated tests, provide the least expensive drug options, and so forth, in order to keep as much of that $200 as possible. 

There would be plans to be followed.  Try the least expensive option known to be effective first; if that doesn't work, escalate the treatment.  There would be much more emphasis on wellness education, known prevention techniques, and so on.  Nursing homes would be brought into the program, and people could use any home in the network.

Because Maine gets a 65 percent match for MaineCare from federal dollars, it makes far more sense to expand MaineCare to healthy young adults and families under this sort of plan than it does to cut them off.  The average young adult won't use his $200 monthly allotment at all in any given year, giving the hospital network a little added income, and if he needs medical treatment for, say, strep throat, he is far more likely to visit his primary provider than go to the emergency room if it has already been set up ahead of time.  A family of four's annual fee of $9600 (at $200 per month per person) would be unlikely to be used in a given year for minor childhood ailments, well-baby visits, a childbirth, or even the occasional broken leg, and pales in comparison to the total average fee-for-service costs for the same family currently being spent under MaineCare of more than $32,000.

With reliable and predictable health insurance rates, companies may well see one of the major barriers to Maine investment will vanish.  But we need to make sure that we keep a healthy and stable population.  LD 1333 is not the way to do it.

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