In his recent guest editorial (Another View, March 17), Jonathan McKane, insurance industry ally and former Newcastle legislator, disagreed with Les Fossel (Maine Voices, March 11) that “we have tried everything else” to manage health care costs and should now embrace universal health care. McKane asserts that we should adopt a market-driven approach, as exemplified by Public Law 90, enacted by the Legislature in 2011 – which, McKane modestly omits, he sponsored.

McKane recalls community rating and guaranteed issue laws of the 1990s meant to help older and unhealthy Mainers facing unaffordable premiums or denial of coverage. But those reforms exposed insurers to “less than favorable results for the carriers in the market,” in the words of a Milliman, Inc., report commissioned by America’s Health Insurance Plans, an industry lobbyist.

This caused a “death spiral,” an actuary’s epithet that McKane resurrects from the Milliman report.

The Milliman report recounts that these reforms caused premium hikes, enrollment reductions (the “death spiral”) and the exodus of individual health insurance carriers from Maine; hence, the insurance market’s “death.” The implicit conclusion: Guaranteed issue and community rating should be rejected to “stabilize the insurance marketplace and provide consumers more choice and access to coverage.”

McKane credits PL 90 with lowering premiums, reducing deductibles and encouraging policy enrollment, declaring, “it worked.” PL 90 “worked” for the health insurance industry, but it didn’t work for Mainers, particularly those whose risk status raised their premiums up to 80 percent: older people, rural Mainers and small-group policy holders whose renewals decreased. “More (younger, healthier) people entered the insurance market,” but the percentage of uninsured Mainers increased.

Maine health care consumers have no “choice” when prices are negotiated between rapacious insurance carriers and providers. There’s no “choice” for you or your employer when confronted by high-deductible plans or preferred provider organizations or when you merely can’t afford health insurance.

Real choice is provided by a single-payer, universal risk pool/practitioner/institution-participating program.

Stephen Small

Portland