Maine’s Health Care System:
The Answer is Hiding in Plain Sight
Testimony by Philip Caper, M.D.
Before the Insurance and Financial Services Committee of the Maine Legislature
February 9, 2011
I am Dr. Philip Caper. During my 45 year career I have served as a physician, policy maker, educator, researcher, manager and entrepreneur. I am here today to testify in favor of LD 57.
I currently serve on the board of Maine Allcare. Maine Allcare is a non-partisan, non-profit group committed to educating policymakers and the Maine public about how to improve upon the Patient Protection and Affordable Care Act (PPACA) in order to make health care in Maine universal, accessible and affordable for all. Today, I speak as an individual.
I am a physician. I am neither a diplomat nor a politician. I leave work that to others better suited to it. I hope you will forgive me if I speak the unvarnished truth as I see it about the problems of our health care system and how to fix them.
Physicians have an obligation to provide medical care to anybody who needs it. We don't have the luxury of deciding who is worthy of medical care and who isn't. We leave that to others.
Most physicians' interest is in a health care system that facilitates our ability to do our job. Our current system gets actually gets in our way of our ability to do our job.
Here are some of the reasons:
- We in the United States are at the end of a thirty year experiment of relying on the invisible hand of the market to manage our health care system. That experiment has failed and has lead to the present state of health care in our country:
- out-of-control costs (even though we already spend far more than any other country in the world) that are increasingly on the way to bankrupting individuals, businesses, and state governments. Health care costs are the single largest contributor to the federal budget deficit
- unacceptably large and rising numbers of uninsured
- routine interference in medical care decisions by private interests not directly involved in the care of affected patients
- uneven quality and mediocre outcomes compared to our international competitors. Our cruel and unfair health care system has contributed to thousands of unnecessary deaths and untold emotional and economic suffering. The United States is also losing the race for improvements in life expectancy. Life expectancy in the United States today is shorter than in 26 other countries according the the World Health Organization
- Market forces don't work in healthcare as they do in many other areas. This is due to at least two characteristics of health care
- There is a lack of information and transparency that is essential to rational decision-making about purchasing care
- There is a lack of the ability in many instances to make decisions free of coercion, due to the stressful circumstances that surround much of medical care
- It is not possible to predict for any individual what their health care needs in the future are going to be
- Health care has become so expensive that it is simply unaffordable for a growing proportion of Mainers.
These factors—all critical to a functional market—have lead to the failure of market forces to control costs or to assure access to care for millions of Americans and many thousands of Mainers. If there is one thing the experience of the past thirty years should teach us, it is that market forces alone have not, will not and cannot work in health care.
Increased competition among health insurers—including the sale of policies across state lines—can only lead to a race to the bottom.
- skimpy policies
- cherry-picking of beneficiaries
- denial of care
- erosion of consumer protections.
The more insurers there are, the weaker the ability of each to control overall underlying health care costs and the higher the costs of administering each policy.
More choice is not necessarily better—one thing my experience during the past 45 years has taught me is that while most people value choice in selecting their health care, they are indifferent to choice among insurance companies. I have never heard a Medicare beneficiary complain that they are unable to choose a private insurance company for basic coverage. Medicare has taught us that choice of insurance companies is not necessary to have choice of medical providers.
The only proven solution for expanding coverage while reducing costs is a single payer or single payer-like system. Such systems are currently functioning well in Switzerland, Germany, The Netherlands, Britain, Canada, Australia, New Zealand, Taiwan and many other countries.
The previous legislature heard testimony from Professor William Hsiao, an internationally recognized and respected expert on healthcare around the world, and primary architect of the successful transition of Taiwan from a system very much like ours to a single payer system. By moving to a single-payer system , he predicted, Mainers could save 10% of total health care spending or $1 billion in the first year alone. Single payer would also reduce the rate of health care inflation permanently by 2% every year into the future. This is not speculation, but is based on the demonstrated performance in many other countries including Taiwan.
Control of underlying medical costs is essential. Experience in many parts of the world has taught us that expansion of coverage and effective cost control are two sides of the same coin. Evidence from thoroughout the world teaches us that this is possible only through a single-payer type system.
Some of the advantages of single-payer could be achieved by the creation of a private—but non-profit—administrator, operating under strict rules in order to maintain both universal coverage and the cost containment necessary for the sustainability of the program
All of this real world evidence makes an examination of single-payer a mandatory part of any serious effort to begin to repair our badly broken health care system. Passage of LD 57—preferably at a significantly higher level of funding—is a modest first step in that direction.
A Medicare-for-all type program is now favored by at least a third of the American public, and a majority of Maine physicians. The failure of legislative bodies to consider all legitimate ideas is a violation of the spirit of the American tradition of free speech. It is also an abrogation of the obligations of legislators to their constituents.
One of the most curious aspects of the recent national debate about health care reform was the conscious and deliberate exclusion of any serious consideration of single payer—otherwise known as Medicare-for-All.
This was especially highlighted in the case of the Senate Finance Committee where Maine is represented by Senator Snowe. After failing at more conventional attempts to be heard, single payer advocates, vigorously protesting their exclusion from the proceedings, were actually arrested at a Finance Committee hearing for pressing their right to be heard.
The first amendment was enacted by the Founders to assure that all ideas, no matter how unpopular or threatening they are to powerful corporate or political interests, could be expressed and given serious consideration. The bill that is the subject of this hearing is one very modest attempt to facilitate the exploration of such an idea.
With Professor Hsiao's help, a single payer system is being seriously pursued in our neighboring state of Vermont. Vermont's governor Peter Shumlin believes that by relieving businesses of the albatross of health care costs now hanging around their necks such a system would be a boon to the business climate in Vermont.
If by creating a single-payer system Maine were able to come anywhere near achieving the health system performance predicted by Professor Hsiao, enactment of this bill could be the best investment in state government you've ever made.
The answer is hiding in plain sight!