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Proposal for true "patient freedom” – Healthcare for all Maine

February 16, 2017

We of Maine AllCare believe in Healthcare for Everyone in Maine.  Both Democrats and Republicans in Congress have seemingly surrendered on any national initiative to cover all Americans. One state will probably lead the way by covering its residents. Why not Maine?

America treats healthcare as a commodity like automobiles, where profits, return to investors and sales and marketing initiatives are king.  Yet millions who cannot afford this commodity suffer untreated illnesses, even death, or financial ruin due to healthcare costs. Economic impacts such as lost workdays cost employers and employees billions, and uncompensated care is crippling hospitals that are major employers. Universal healthcare coverage is more than an inspiration of morality, it is an economic necessity.

“The status quo is unsustainable, for patients, for workers and for employers" said Henk Goorhuis, MD, Board Chair of Maine AllCare at a recent national meeting of the activist organization ‘Healthcare Now.’” “Further, the ideas pushed by the Republican majority in Congress, which are based on even more privatization and patient cost-sharing, would only exacerbate our citizens’ healthcare access problems.” Available data show that this could mean an additional tens of thousands of unnecessary, preventable deaths, according to a January 23rd Washington Post article by NYU physicians David Himmelstein and Steffie Woolhandler.

Medicare provides healthcare coverage for older Americans, and created funding outside of the "commodity" system. Publicly funded, operating with low administrative costs and delivering private care, Medicare covers millions of satisfied citizens. With an "Expanded and Improved Medicare for Everyone," as thoughtfully and carefully detailed in a bill re-introduced by Rep. John Conyers (D-MI) and cosponsored by 57 others including Rep. Chellie Pingree, proposing a national universal healthcare system, everyone could win. Despite strong public support in many surveys, stronger forces in Washington successfully suppress any discussion of “Medicare for All.”

The Affordable Care Act (ACA) tweaked the commodity system by making federal subsidies for insurance available. Over 20 million more Americans, including about 75,000 Mainers, have coverage, many for the first time ever.  ACA required states to expand eligibility for Medicaid, but the Supreme Court gave states the option to decline, and Maine declined. Although a success for millions, the ACA, and Maine’s failure to fully implement it, leaves in excess of 100,000 Mainers – 8-9% of us (2015 Census data shows 111,000) – with NO coverage.  70,000 would be covered had we expanded Mainecare under the law. And many who signed up will drop out because of backbreaking deductibles and prohibitive premium hikes that only satisfy for-profit insurance companies.

What about a replacement? All Republican proposals, such as "vouchers" and "block grants" merely tweak the current, market-based system. This includes Senator Collins’s “Patient Freedom Act of 2017” that favors people who can afford to participate. The Act’s proposed subsidies for Health Savings Accounts require that people continue to purchase market-based insurance plans. Hard working Mainers living paycheck to paycheck, as well as those without any paychecks, will still be left behind. In federal budget battles, appropriations for vouchers and block grants and subsidies for “Freedom Act” Health Savings Accounts will be forever unreliable. 

However, with a section 1332 “waiver” allowed by the ACA, federal healthcare money designated for Maine could be used to chart Maine’s own course to universal coverage. With comprehensive health care for all, which will include all Mainers – even the healthy – the per capita cost is lowered at the same time the commodity problem is eliminated. Everyone will be in. No one will be out. Access will be simple. Coverage will be comprehensive. Everyone will pay with equitable financing.  No one sector will be overburdened. Healthcare providers will return to a professional mission. They will care for patients without the shackles of running a complicated billing operation.

If we want the best, most affordable and efficient healthcare, Medicare is the best model. Here in Maine, we are ready to move ahead.  Medicare's original rollout took less than a year to enroll everyone.  They used postcards! President Harry Truman was the first enrollee! Surely we could top that.

In this legislative session Maine Rep. Heidi Brooks and Sen. Geoff Gratwick are proposing legislative action that promotes universal healthcare. If the Legislature and the Governor will not care for their constituents, it will be up to us, as private citizens.  Maine AllCare will explore the Citizen Initiative process. It's time to fulfill the Maine State motto and lead this nation in establishing the people-centered, business friendly, rational, moral, affordable, equitable healthcare system we all deserve.

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Signed: William Clark MD, Woolwich, Moira O’Neill PhD, Surry and Joe Lendvai, Brooklin ME. The writers are members of Maine AllCare, a nonprofit nonpartisan organization dedicated to comprehensive, affordable health care for everyone in Maine.

Editor’s note: This op-ed, submitted to a number of major Maine newspapers, was a response to the Cassidy-Collins bill  S.191, an attempt to replace the Affordable Care Act.