The recent excellent reporting on medical billing by Joe Lawlor has prompted a number of Press Herald letters, opinion pieces and an editorial in response. Writers have offered suggestions for improving our health care system: better communication between insurers and providers, legislative action to cap prices, improved transparency, etc.

However, as Dr. Larry Kaplan pointed out in his Sept. 7 letter (“Facility fee bill only a stopgap – Maine needs universal care”), “stopgap” changes to such a complex system are not enough. They’re unlikely, for instance, to improve the patient or physician experience, to control costs significantly, or to ensure everyone is covered. What they will almost certainly do is add to the complexity.

The resolve to which Kaplan referred in his letter would have directed the Legislature to draft a bill that would replace the present system, based on commercial insurance for the healthy and government programs for the poor, old, disabled, et al., with a universal health care system ensuring that all Maine residents had good, equitable health care.

As Lawlor mentioned in his report, some opponents of such reform cite the failure of voters in states where it has been proposed (Colorado, Vermont, California) to pass enabling legislation. That is less an indictment of those plans, though, than it is of the factors responsible for their rejection: failure to specify and explain the costs and funding of the plans, failure to educate voters about how the plans would work as opposed to how the present system works, and opposition by special interests (e.g., insurance and pharmaceutical companies) concerned about financial losses. Therefore, achievement of comprehensive reform of this type would require not only developing the plan itself and putting it into bill form, but dealing with the three factors that would otherwise doom the bill’s passage.

That could be done. Here’s one way.

Establish a legislative committee made up of members and consultants experienced in health care policy and devoted to development of a universal health care bill, not to representation of all stakeholders’ interests.


As more than 20 other states have developed universal health care plans, the committee could begin by reviewing those plans, along with plans that have been developed previously here in Maine (most recently, L.D. 1045 in the 130th Legislature).

It could also review the 30-odd fiscal studies of state-based universal health care plans, most of which have projected reduced health care expenditures once the plans are fully implemented. With that background in hand, the committee would then develop the plan, making the final bill detailed enough to allow for federal waiver applications and an objective fiscal analysis.

The bill would need to include several additional provisions:

• Its implementation would be contingent on obtaining the waivers and on commissioning and completion of the fiscal analysis, including the effects of the plan on specific demographics (employers, workers, health care professionals, retirees, et al.).

• It could be modified until the Legislature finds the analysis of the plan acceptable, including a projection that the total cost of the plan would be no greater than the present state health care expenditure.

• The citizenry would be kept informed about the contents of the bill during its development and have opportunity for comment. Final approval or rejection could be left to the voters rather than the politicians – they’re the ones to be affected by it, after all.

Such an approach to health care reform would ensure that the final plan would be assessed on its merits and that the countervailing factors would be minimized: Costs and funding would be front and center, the people would be enlightened about how the system would work, and as for the opposition of special interests, well, the voters would see through that soon enough.

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