Dr. Erik Steele, chief medical officer for Eastern Maine Health Care Systems in Bangor and a columnist for the Bangor Daily News, a few weeks ago gave a striking talk to a gathering of the Maine Health Management Coalition titled, “Maine is Burning.”
Dr. Steele pointed out that if the recent trend of cost increases continues, healthcare costs may consume as much as 40 to 50 percent of the typical family income in 10 years, while family incomes have been largely stagnant over the last 30 years.
In his words, “in Maine we are going to flatten this healthcare cost curve or it is going to flatten us and progressively marginalize Maine in a national and world economy.”
He urged his audience to join with him in a “tremendous, statewide, multi-stakeholder initiative to reduce utilization of medical services that are of marginal or no real clinical value.”
He pointed out both that significant work by Dr. Jack Wennberg, “has showed again and again that, in general, the more healthcare we get the less well we do, and as much as 40 percent of the healthcare we get produces little incremental health benefits.”
But the good news is that here in Maine, work by the Maine Health Management Coalition and the Maine Quality Forum, part of the Dirigo Health agency, is beginning to identify where best medical practices are producing the best results, and where there is room for substantial improvement by Maine providers.
Most of the discussion of the Dirigo Health program has focused on the Dirigo Choice insurance product, which has allowed over 2000 Maine small businesses to provide coverage for business owners and employees, and continues to cover about 12,000 people, with 1500 people on the waiting list.
Another 6000 are covered by the expansion of MaineCare coverage, which was enacted as part of the Dirigo Health program. These expansions in coverage have been a significant part of Maine’s transformation from having the highest rates of uninsured people among New England states to the second lowest – losing top rank after Massachusetts enacted its universal coverage program several years back.
The expansion of coverage plays one part in reducing costs to everyone else – since those covered are no longer adding to hospital and other providers’ bad debts and charity care costs are passed on to other payers.
But the Dirigo program also has reduced costs by negotiating with hospitals for a voluntary restraint on cost increases to 3 percent, by strengthening the state’s “certificate of need” program to control investment in health facilities, by the efforts of the State Health Plan to focus on cost drivers and by work of the Maine Quality Forum, under the current leadership of Dr. Josh Cutler, to determine how to improve the delivery of health care throughout the state.
Over the last four years, the Superintendent of Insurance has identified over $150 million in costs savings attributable to these various parts of the Dirigo program.
Among the further cost saving changes the legislature added to the program last spring was a “reinsurance” method that will further slow the rate of cost increases for all 40,000 Mainers who buy their own health insurance in the private market.
There is much more that the state can do to build on these beginnings on healthcare cost controls.
Dr. Steele argues persuasively that we need to adopt payment systems that pay a set rate to healthcare systems to provide complete care for their patients.
We need to stop paying for things that don’t promote health. We need to stop promoting products that cause bad health (like sweetened drinks).
We need better controls on new health facilities so that their costs don’t outstrip our community needs and ability to pay.
We need more available and understandable information about where to get the best value for our health care dollars.
We need to drive system costs down by covering everyone.
What we must not do is abandon the efforts to control costs and expand coverage that Maine led before many other states.
Out-of-state beer, wine and soda distributors are spending over $2 million to scare Mainers with the nonsense that a few pennies on their products will lead to losses of jobs and family incomes.
The truth is that higher costs for health coverage are a much worse threat to most Maine families and businesses and the whole economy. We must vote “no” on Question 1 to preserve our good start on more affordable health coverage for all Mainers.
Christopher St. John, Executive Director Maine Center for Economic Policy
The article “Maine is Burning” is available at http://www.anthem.com/wps/portal/ahpmember?content_path=shared/me/f1/s0/t0/pw_ad080276.htm&rootLevel=0&state=me&label=Conference%20Information)
