RICHMOND — Let’s be clear. We haven’t come close to solving the problems with our health care system. The Maine Republicans’ bill, PL 90, didn’t come close, nor does the Affordable Care Act.

Premium subsidies, altered payment systems, Medicaid expansion and other tinkering around the edges of a hopelessly flawed system amounts to rearranging deck chairs on the Titanic if your objective is preserving health and saving the lives of all Americans, not just the politically favored.

Our health care system is built on political favors. Some favor politicians, corporate profits, insurance companies and hospitals. Others favor teachers, unions, the elderly, public employees, the military and the poor.

The ACA is projected to leave upward of 27 million Americans uninsured, equivalent to about 20 times the population of Maine.

Maine’s two decades of health care system reform – including the elimination of medical underwriting before Barack Obama was president – consistently left some 10 percent of Maine people uninsured while continuing down the path of high-deductible coverage, as was once offered through Dirigo Health and is now offered through the ACA’s exchanges.



Insurance with high out-of-pocket costs remains the path to individual bankruptcy for those caught catastrophically sick or injured while covered under plans best described by the wag who first said the only thing worse than being uninsured is paying to be uninsured.

Consider, please, Annie, a 60-year-old widow in Washington County, who, with a salary of $47,000, earns less than the average secondary school Maine teacher but too much to qualify for an ACA subsidy. Because the Affordable Care Act, like PL 90, permits discriminatory rating based on age and place of residence, our widow’s cheapest monthly exchange premium runs $685 for a plan with a $5,000 deductible.

Should Annie develop an expensive chronic or recurrent condition, consider her annual health care expense, which is 31 percent of her income ($8,220 in premiums plus the ACA-capped deductible and coinsurance of $6,350), and start her countdown to bankruptcy.

As Medicaid expansionists argue, apart from the 1 percent, those without decent health insurance risk seriously compromised health and premature death because health care for serious conditions is prohibitively expensive and federal law requires hospitals only to “screen and stabilize” patients presenting at the emergency room.

If an ER screening for pain yields a diagnosis of malignant cancer sure to kill you if left untreated, don’t expect to receive for free the treatment routinely provided to properly insured patients as the standard of care.

The United States remains the only wealthy country in the world without universal health care despite spending, on average, twice as much for a system that ranks comparatively poorly in quality (37th) and outrageously in fairness (54th).


Some 60 percent of Maine people enjoy government-provided or heavily subsidized, comprehensive health insurance, including those covered under Medicare; MaineCare; military health care; plans covering legislators, teachers and other public-sector employees; and now those eligible for the most generous ACA subsidies.

Another 15 to 20 percent have variable-in-quality group coverage, as low-deductible plans are prohibitively expensive in the small-group market where most Maine employers reside.

Put another way, the unsubsidized pay taxes that, in part, go to provide to someone else the coverage they and their families need but can’t afford, which is like paying for public education at schools that your kid can’t attend.

Public education, roads, bridges, parks, libraries, police, fire protection and the common defense. We are all served. That’s what our taxes are for, right? The common good? So what happened to health care?

No one interested in the available facts and evidence can credibly argue that we don’t have enough money to cover everyone, if we were to take what is now being spent and use it to instead cover everyone under a single, administratively efficient, nonprofit, publicly financed system.

That model describes Canadian, single-payer health care, which, along with its name, “Medicare,” we borrowed for our seniors.



Canadian Medicare began as a provincial initiative in Saskatchewan, and fighting for anything designed to achieve less renders insulting claims of “our commitment to the most vulnerable,” “shared responsibility,” “good for Maine people” and (from Affordable Care Act and PL 90 cheerleaders) “affordable coverage.” The routine utterance of such platitudes in support of policies that fall short of truly universal coverage represents the height of political incivility.

“Justice too long deferred is justice denied,” said Martin Luther King, who also warned of “the wounds we inflict on our souls when we look the other way.”

It is past time that we address rather than look away from those who are left uninsured and underinsured by our irretrievably broken, grossly unfair and morally bankrupt health care system.

— Special to the Telegram

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