Chicago Tribune David Greising column: Health care reform: Maine's 'meddling' may lead to mending of broken system

In the push to bring a glint of bipartisanship to the impending party-line vote on health care reform, it is beyond ironic that the two hotly desired Republican votes both come from the state of Maine.

Maine is, after all, one of only three states in the union that have implemented major health care reform that embraces some of the much-discussed mechanisms of the current congressional debate.

Maine is, according to the critics, also an example of how health care reform has gone wrong. Designed to lead the way toward universal health care coverage, it has fallen woefully short. Aimed at keeping costs under control, it has failed to do that too.

That is what the critics say, anyway.

Maine's reform efforts have had their problems. So have those of Massachusetts, where a push toward universal coverage has not led to the reduction in costs that promoters promised.

Some of those problems, though, have been addressed along the way. Others are not yet fixed.

Regardless, say those who believe in the need for national health care reform, problems in reform efforts in Maine, Massachusetts and Vermont -- the three states that at least have given it a try -- merely highlight the need for a federal approach.

In fact, said Rachel Nuzum, senior policy director at the Commonwealth Fund, Olympia Snowe and Susan Collins, both Republicans of Maine, likely have expressed a willingness to consider voting for the Democrat-drafted reform plan that emerged from the Senate Finance Committee this week in part because of the mixed record of the 6-year-old reform program in Maine.

"The fact is that they, better than a lot of other senators, have firsthand knowledge how difficult this is to do at the state level," Nuzum said. "That's why they are more open to a national program."

When the politically middle-of-the-road Commonwealth Fund studied the results of Maine's effort at the five-year mark, it found clear shortcomings. By late 2006, the effort designed to broadly expand health care coverage had enrolled only 10 percent of previously uninsured residents.

One of the reasons for the shortfall: Expected cost savings did not materialize, so the state insurance program could not afford greater enrollment in the state-funded coverage plan. This disappointed thousands of people who applied but were not accepted, and it remains a chief cause of the underenrollment that persists today.

Despite the shortcomings, though, the Maine program did succeed in expanding health coverage to people who previously were uninsured.

According to the Commonwealth study, as many as 36 percent of those who enrolled in Maine's state-funded program previously had no health coverage.

In other words, the health plan did expand the rolls of people with health coverage, and the fact that thousands were turned away indicates a robust demand for coverage.

Demand for coverage is a big issue because one of the hottest political issues of the current debate is whether the federal government should "mandate" that people who can afford health insurance must actually get it. The plan proposed by Sen. Max Baucus, D-Mont., includes penalties for those who do not comply.

This has engendered some outrage among people who want minimal government and who, apparently, are comfortable living in a country where people can "free ride" the system by not buying insurance, knowing all along that the taxpayers or hospitals will come to the rescue should they get terribly sick.

The Massachusetts program has nearly all the moving parts discussed in the current national debate. Seeking near-universal health insurance coverage, it relies on expanded Medicaid coverage, subsidized private insurance, a state purchasing pool and mandates requiring many employers to provide coverage and individuals who can afford to do so to buy it.

Two years into the program, in the summer of 2008, only 2.6 percent of the population had no health insurance. Costs exceeded projections, and in some instances there were shortages of providers and available care. The projected $1.3 billion cost of Commonwealth Care for 2009 is double the spending on the program in 2007, according to state figures.

There are some who see the problems with programs in Maine and Massachusetts and argue that is the reason the federal government cannot afford to meddle in health care.

But with health care insurance premiums eating up 18 percent of the typical family's income, en route toward a 24 percent bite in 10 years if nothing is done to "bend" the cost curve downward, it's not a question of whether the federal government can afford to meddle in health care more than it already does.

The government already meddles in health care, and even the flawed Maine and Massachusetts experiments show that government intervention is better than no action at all.

The only way to bend the cost curve is to adopt national efforts, while remembering the lessons of Maine.