Trish Riley’s Maine Voices column has encouraged me to add my two cents’ worth to the MaineCare debate (“Accepting federal funds, containing costs makes sense for MaineCare,” Jan. 20). I recall fondly that when I served on one of Trish’s planning committees, I brought up the paucity of the Medicare payment system, which resulted in a shift in payment to the private payer and their private health insurance rates.

At the time the Medicare “shortfall” averaged something like $2,000 per Medicare patient per year. The 2012 estimate by the Maine Hospital Association is that Medicare now pays 86 cents of every dollar of costs, and Medicaid (known here as MaineCare) pays 75 cents. Changes in the Affordable Care Act will certainly add to those payment deficits.

Part of the discussion then was on then-Gov. John Baldacci’s economic stimulus program to attract old people to move to Maine. Maine now leads the nation in old people, so it apparently worked. The economic development plan now being promoted is to add thousands of MaineCare recipients to the rolls, with the resultant expanded cost shift to private payers. The government’s continued failure to modernize and simplify its payment systems to rectify these problems is a disgrace.

Proponents of MaineCare expansion argue that in its first years, the expansion will cost us nothing. That is to assume that we do not pay federal taxes, or that we rely on those in other states who pay more taxes than we do.

The belief of some that a $17 trillion debt (and growing) is not to be worried about belies the fact that at some point we must pay the proverbial piper, or collapse in a smoldering heap of smoldering debt. Perhaps this is an old-fashioned attitude; it is, however, mine.