One of the laws to emerge from the just-completed session echoes a familiar goal. In the words of Gov. John Baldacci, this legislation will help “make quality, affordable health care available to all Mainers and to work to make Maine the healthiest state in the nation.”
If the words sound familiar, it is because they have been the promise behind Maine’s Dirigo program since 2003. Dirigo deserves credit for helping to make Maine a healthier state, but it has failed to generate enough income to adequately support a public health insurance plan.
The latest chapter in Dirigo’s struggle to survive is the decision to establish a flat fee on insurers. It’s another step down from its original goal of establishing a public health care plan built on low premiums and savings wrung out of the health care system
One of the lessons to be learned from Dirigo’s struggles to recoup these savings is that reforming health care will take considerable muscle. Without sufficient resources, Dirigo’s rolls never exceeded 15,000, and enrollment has been closed since 2007.
Health care reform is now at the top of the national agenda and a compromise plan recently emerged. The plan, proposed by former senators George Mitchell, Tom Daschle, Bob Dole and Howard Baker, raises several difficult issues, calling for levies on firms that don’t offer coverage. Also on the table are proposals to require everyone to buy or arrange for coverage, and limiting the tax break workers now get for health benefits.
But the compromise doesn’t address the controversial idea of establishing a national public plan. Instead it leaves the option of public plans to the states.
Maine’s effort to do so raised unrelenting political opposition and lawsuits. Unless Dirigo can come up with a new source of income, it is hard to imagine it achieving its early ambition of providing an affordable option to Mainers without health insurance.
Only the federal government has the resources and clout to make a public plan work. Such a plan would have a much stronger chance of reaping the savings necessary to support it. And a public plan could also provide the competitive pressure needed to force private insurers to lower costs and improve services.
Without such competition, there is little hope of keeping health care costs under control. A public plan would not drive private insurers out of business; it would simply force them to provide better service and control their costs.
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