DAMARISCOTTA — As the Maine Legislature considers the governor’s proposed biennial budget and its injurious cuts to hospital-based physicians, I am reminded of my experiences as an emergency physician in California 30 years ago.

Like many physicians throughout the history of medicine in the United States, I completed my medical training in a large county hospital.

In the mid-1980s, a two-tiered system of health care was firmly entrenched in California, where the poor and uninsured were cared for at public county medical centers, and the affluent, privately insured received care at private hospitals.

The disparity in care was evident. Public hospitals desperately negotiated with the county for the resources needed to keep their doors open. Private hospitals routinely refused indigent patients and referred them to the county facilities.

Disadvantaged patients were forced to travel great distances for care, and because county hospitals did not turn anyone away, wait times were lengthy and resources were strained.

It was not unusual for patients with even the most acute conditions to wait inordinate amounts of time to be seen by a provider, if they were seen at all. These inequalities led to poor patient outcomes, including needless suffering and countless deaths.

I recall one uninsured working man, in particular, who came to our county hospital with a horrible eye injury.

“John” had already gone to a small emergency department seeking care. Seeing that the patient clearly needed specialists and treatment his hospital could not provide, the emergency physician there desperately called a number of other hospitals, and each one flatly refused to provide John care because he had no insurance.

After inappropriate delays, he was finally transported to receive care at our county hospital, a great distance from his home.

This experience, and others like it, underscored for me the fundamental failure of a health care delivery system that would turn its back on the most vulnerable.

I relocated to Maine in 1989, drawn not just to its beauty and the professional opportunities it provided, but also to its ethos and leadership in providing access to high-quality health care for all of its residents. Maine’s Legislature, hospital systems and providers have an outstanding legacy of sharing the responsibility of providing access to care for all, regardless of ability to pay.

And this approach has worked. In his recent keynote address at the Maine Quality Counts conference, renowned author, surgeon and professor Atul Gawande, M.D., stated that Maine is ranked in the top quarter of states for best outcomes – a quality measure – and the bottom quarter for Medicare costs. This is a model of which we should be proud.

In recent years, however, budget cuts at the state and federal level have threatened Maine’s successful model of care. The state’s decision not to expand MaineCare eligibility – in fact, to reduce eligibility over the last two years – resulted in over 50,000 people losing MaineCare coverage.

As a result, MaineHealth’s local health systems are providing more charity care than ever before. Combined with over $300 million in cuts to state and federal payments over the last five years, the current budget proposal threatens access to the services that provide the foundation of our high-quality system – services such as primary care, mental health treatment and support for community programs that serve the uninsured.

The proposed cuts will create a gaping hole in the safety net designed for those most in need. Critical programs and services will face cuts never seen before, and the under- and uninsured will bear the brunt.

Because jobs represent 70 percent of health care costs, these cuts will also result in reductions in staffing. Maine is already challenged to attract and retain primary care physicians, nurses and other specialists to our largely rural state. The long-term repercussions of this short-term budget fix will affect access to care for future generations in our state.

We are at a crossroads. Maine is poised to embark on a path of haves and have-nots, where equal access to quality health care for all becomes a lost ideal.

It would be a tragedy to create a system similar to that in which I worked in California. Maine’s health care system has upheld its ethical responsibility and commitment to provide high-quality care for all. We ask the state of Maine to uphold its responsibility as well.

 

Copy the Story Link