SOUTH PORTLAND – As a registered nurse with over 45 years experience in health care, I would like to respond to Rep. Deborah Sanderson’s statements in Maine Voices, Dec. 30, 2011 (“Legislature is tackling the causes of Maine’s high health care costs”).

Rep. Sanderson lists three reasons why health insurance costs in Maine are high compared to much of the nation.

She identifies high cost of care in Maine, a large medical welfare population and restrictive health insurance laws.

She states that the Legislature is working to resolve these three and other related issues. Probably almost everyone can agree that health care costs need to be reduced.

It would be good to decrease the need for welfare, and it would be wonderful to have a health insurance marketplace in which patients had a real choice of plans with the assurance of basic, decent, safe health care.

What we seem to disagree about is how these aims should be achieved.

Rep. Sanderson describes the removal of the Certificate of Need process as a step in reducing health care costs.

But the Certificate of Need law was established to decrease health care costs with the rational that as hospitals compete by acquiring more and more expensive equipment and programs in an attempt to lure prestigious doctors and more patients, the cost of health care increases.

Furthermore, there is evidence that outcomes are better when a facility does a fairly high volume of a procedure.

Sanderson states that allowing insurance companies to offer financial incentives for clients to travel for treatments will decrease costs.

If, instead of “client or customer,” one uses the word “patient” which has the connotation of sick and vulnerable, one can visualize the discomfort of the aged and infirm driving over Maine country roads which are covered for much of the year with ice or snow.

A look at a map of Maine and its hospitals will quickly illustrate that distance is a huge factor in access to care.

The revised insurance law that Rep. Sanderson praises allows health insurance companies to charge according to perceived risk of the workers.

This benefits young and healthy workers with little risk of occupational injury and prices others out of the possibility of being insured.

A guaranteed access plan is supposed to help out this group.

This high-risk group is supposed to be supported by a surcharge. However, the surcharge that contributed to Dirigo Health was fought every step of the way.

It is hard to see how this would be perceived differently.

Increased competition in health insurance markets might be better achieved by having significant consumer representation in planning the insurance exchanges of the Affordable Care Act.

It is not surprising that MaineCare costs (Medicaid) are high in this state.

Maine has one of the oldest populations in the nation. MaineCare makes assisted living and nursing home care possible for those unable to manage on their own.

MaineCare is a program that allows many who do not have access to employer based or individual health insurance to have access to health care.

If one travels around Maine, one does not see huge companies that are able to provide health insurance to workers. Instead one sees many unemployed due to industry and business closings, the self-employed and small businesses.

Wages are not high and cost of living is. MaineCare provides critical access to health care in this large, rural state.

Rep. Sanderson uses the term “medical welfare program.” This term has the negative connotation of health care as a privilege rather than a right.

Health care involves the very life and well-being of citizens.

Moral-ethical issues interact with economic issues.

What is most efficient to do, may not be morally-ethically acceptable.

Competition and market forces in health care require some regulation to achieve equity, just and humane outcomes.

It is painful to consider that those who are comfortable today could easily lose a job and health insurance tomorrow.

It is easier to think that “we” are strong and ambitious and “they” would be OK if only they tried harder.

If we made social policy on the concept of “there but for fortune go you or I,” we could create a health care system where every member of society has access to a basic level of health care.

Costs can be decreased when appropriate quality of care is provided.

As health care needs are addressed, people can contribute more to society.

The analysis of Rep. Sanderson does not represent the best way to address health care costs and social needs.

Susan Henderson, RN, MA is a nurse who lives in South Portland.