Chronic MaineCare shortfalls — a symptom of a disease we can treat
By Philip Caper, M.D.
Bnagor Daily News, Dec. 27, 2012
About a year ago, facing a budgetary shortfall, the Maine Legislature had a knock-down, drag-out fight over Gov. Paul LePage’s proposal to save $220 million by throwing 65,000 Maine residents off MaineCare.
At that time, I predicted that the Legislature “can look forward to a repeat performance in a year or two unless they have the courage, wisdom and bipartisanship to attack the fundamental flaws in the ways we finance and deliver [all] health care services.” Well, they didn’t. And now they are.
The recently announced “unexpected” cost overrun of more than $100 million attributable mostly to MaineCare will no doubt lead to a repeat of last year’s fight. At the same time, Maine hospitals are clamoring for almost $500 million in past-due MaineCare payments.
The Legislature is now under different management. Maybe the Democrats can succeed where the Republicans failed. But to do so they will have to finally be willing to look at the big picture.
At a national level, Congress and the Obama administration are contemplating cutbacks in Medicare eligibility as one way to reduce federal spending. Such cuts, like those in MaineCare, will simply shift those costs to the private sector.
That shift will only exacerbate existing private-sector health care cost problems. Out-of-control costs have had a dampening effect on employment, depressed wages and discouraged entrepreneurship by creating job lock. They have also encouraged employers to shift whatever costs they can to their workers and to public-sector programs such as MaineCare. Walmart is the poster child for this phenomenon, but it’s hardly alone.
MaineCare cost overruns are only a symptom of larger problems in our health care system as a whole. They cannot be solved in isolation. Trying to do so is a losing strategy.
The Legislature now has an opportunity to revisit a solution they have failed to embrace in the past under both Democratic and Republican leadership — movement toward a single, publicly managed health care system for all the people of Maine.
Such a system would cover everybody, and would be a big step toward eliminating the billions of dollars of health care waste due to fraud, overtreatment, inefficiency and unnecessarily high prices. It could do so for no more than we are now spending.
It would also enable us to control total health care spending in ways far less intrusive than our current system. How is this possible? Here’s an analogy.
If a rancher has a herd of cattle and wants to limit their grazing to a limited amount of land, he can accomplish that in one of two ways. He can either tether each of the cattle to a leash (and hope they don’t find a way to break loose) or he can build a fence that effectively encloses all of them in their pasture. Controlling the entire herd is both more effective and less intrusive than trying to control individuals.
In health care we have tried tethering (mostly through private insurance companies) by restricting the individual actions of both health care givers and patients. It hasn’t worked.
A single, publicly financed and managed health care system will permit us to create a fair, unified, simplified and enforceable budget for all health care in Maine, while at the same time reducing our intrusive management of individuals’ health care decisions. It would give everybody in Maine a stake in seeing to it that the system that includes everyone works well for everyone.
As I’ve written before, Obamacare is in some ways a step in the right direction, but it’s far more complicated than need be and will not be as effective in constraining health care costs as it must be. But it does contain provisions that would permit Maine to set up a program that would provide the tools to manage the competing claims and objectives of different stakeholders. We could simultaneously improve access to care, the quality of care, and restrain the rise in costs for everyone in Maine.
I hope the Legislature takes a serious look at this approach in the coming months as they struggle with their daunting budgetary challenges. It will not be easy. That’s why it hasn’t been done before.
But if we are willing to treat the underlying pathology of our health care system instead of just the symptoms, we will have taken the first step toward fixing it. If not, we will be fighting the same fights next year and the year after.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org.