By Tom Dunne
Copyright centralmaine
Tom Dunne of Cape Elizabeth was the first executive director of the Dirigo Health Agency during the administration of Gov. John Baldacci.
There are a lot of people running to be our next governor. Sadly, no one has (yet) loudly proclaimed a strong, simple reason to vote for them. Sure, standard platitudes are being spoken but nothing really stands out.
I am waiting for a candidate who loudly and simply says: “I am running because we need major health care reform and smarter government.”
There are many issues to debate and be worked upon — economic and cultural — and most of these topics can be framed under “smarter government.”
The next governor should sway efforts in jobs, housing, taxes, education, immigration, reasonable boundaries around trans issues, etc. Each is an important topic, but one bigger broader issue needs to be aggressively addressed: health care.
The U.S. spends 17% of our economy on health care while other Western nations such as Germany, the U.K., Australia and Canada spend between 9 and 12%. Sadly, outcomes and satisfaction ratings are better in most other countries.
Our health care system has metastasized to the point that it is crowding out spending in other important areas. It is essential to start diverting some of this spending to education, housing, police and fire, roads, internet infrastructure and maybe lower taxes. Reducing annual health care spending by 1% of Maine’s GDP is worth approximately $750 million per year.
A starting list of areas for reform: charging and payment systems; contracts; how hospitals and institutions budget; infrastructure; insurance (including the very role of the carriers);prioritization and decision-making broadly and at the patient level; and incentives for patients, providers and insurance carriers.
Profits and compensation in too many pockets have surged well past the point of fair value or what is the true market value. Better regulation and taxation is needed, especially on for-profit institutions. Better legislative and regulatory review on nonprofits is essential. Simplification, eliminating the middle person and tough negotiation on fair compensation are starting points.
Some may proclaim single-payer is the answer. It might be part of the answer but on its own,or as a starting point for reform, it is likely to disappoint. The lesson from elsewhere, including Vermont, is the math does not work. Without major reform first, a “Medicare for all” system is not economically viable.
Better is possible. Looking around the world, there are several health care models Maine could move toward that spend less, deliver more and are a fair cultural fit.
Many health care people and institutions know there is the need for change, and they will welcome it when and if there is simple, clear guidance on a new model for our health care system.
Who will be against reform? There are a lot of people and a lot of organizations making a lot of money in the current system and their historic answer to potential change is to say: “If we spend more money, we can be even better.”
Sadly, we are way past the point where that attitude is healthy. To a high degree, this is about money. It’s time for an adult conversation to say “enough.”
Fear of change is real, for both providers and patients. Countering fearmongering, education and leadership will be essential for success.
Our next governor needs to lead. National reform is unlikely. On their own health care institutions are limited in what they can do. States have a history of successfully innovating in health care, including Maine. It will not be easy, but a governor is uniquely situated to uselegislative action and the bully pulpit of the office to lead this admittedly difficult task.
I don’t want to run, but someone needs to step up. I’d rather coach, partially since I’m old-ish and it’s time for the next generation to lead.
Candidates, given the recent fundraising calls to my house, many of you know how to reach me if you want to talk. Voters, ask questions and insist on better.
