The other day, my daughter came down with a cold and had pink eyes.

This troubled her mother, who was afraid that it was “pink eye.”

I write this not because I want your sympathy (everybody’s fine now), but for what it says about our combination of health care payers and providers that we like to call a system.

As everybody who’s had kids knows, pink eye, or conjunctivitis, is both highly contagious and easily treated. All it takes is a little ointment in the eye, but the medication is only available by prescription and the doctor usually wants to take a look.

Our pediatrician did not have any open appointments that day, so the office suggested going to a drop-in clinic. That led to a call to our insurance company to see if a clinic visit would be covered. The answer: no.

But the company representative offered an alternative: A trip to an emergency room would be covered. That’s right, an emergency room.

So instead of paying $50 to $100 for a doctor’s office visit, the insurance company recommended visiting an ER for 10 times the price.

This is not the worst horror story about health care delivery in America, but it is an example of what’s wrong when you organize your whole system around the needs of the insurers. It also tells you what’s wrong with Republican plans to give even more power on the state and national level to companies that are more interested in their cash flow and share price than in the needs of families like mine.

Republicans in Congress and the Legislature have put forward plans in Washington and Augusta, and in both cases the mantra is using market forces to drive down health care costs. But that’s not necessarily how insurance works.

Insurance companies care about their costs — what they pay out — and if they could, they would lower them by paying for less, even if that means covered people may get sicker. In states that let them, they do just that, dropping patients when they get too sick or capping lifetime benefits. Leveling the playing field among the states was one of the major accomplishments of the Affordable Care Act.

If we listen to the party of Lincoln (and Trump), the answer is more competition. But that won’t work if the insurance companies are just competing with each other to lower their exposure. If the overall cost of health care keeps skyrocketing, it’s not really a problem for them as long as they take in more than they pay out. But for society as a whole, health care inflation is a crisis.

The Republican deficit reduction plan written by Rep. Paul Ryan would turn Medicare into a voucher program, capping over time how much the government would pay for each person’s coverage and letting the insurance company take that and whatever else they can get from consumers. If the premiums keep rising and the people can’t afford the coverage, well, that’s their problem.

In Maine, the Republican approach to lowering prices for the individual market is to loosen the rules and let insurance companies deny coverage to people who are sick, reducing premiums for the rest of us. The sickest people would be covered by a government-subsidized plan that all others with insurance would pay for through a tax on our premiums.

They say this will increase competition. What they can’t tell you is how competition is going to lower costs.

They don’t have any competition in Canada, and they pay half of what we pay in the U.S. My insurance comes through my employer in the group market, which is much more competitive than the individual market. My rates have gone up by double digits nearly every year, and my out-of-pocket costs are through the roof.

Competition has a role, but what will really reduce insurance premiums for consumers is lowering the cost of health care itself. The only way to do that is to pay for fewer services.

We all know how the insurance companies would handle that, but I prefer a different angle: Make people healthier. That means money for preventative care as well as lifestyle coaching on smoking cessation, diet and exercise.

The next step would be focusing on the caregivers, not the payers, giving incentives to medical practices that manage people’s health and get good results. That could mean paying a primary care physician by the patient instead of by the test.

In the end, my daughter didn’t go to the ER. We are lucky to have a clinic in her high school run by the city’s Department of Public Health (the clinic is something else the Republicans are always wanting to shut down).

It turns out, her eyes were just a little pink after all.

Greg Kesich is an editorial writer. He can be contacted at 791-6481, or:

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