Maine’s Department of Health and Human Services is in crisis, and it has been proposed that health care coverage be cut to some 65,000 people in Maine.

Cutting services is an easy solution but one that is short-sighted. It’s as if you have a hole in your car’s gas tank and you decide to fill your tank less often to save money. The hole is still there draining precious fuel.

There is a hole in our current system of health care, and money is leaking out, being wasted. The shortage of money isn’t because we cover too many people, it’s because the money isn’t well used.

Michael Lewis’ book, “Moneyball,” makes the same point: “In professional baseball, it still matters less how much money you have than how well you spend it.”

Cutting services won’t help to spend the money any more efficiently.

Our current health care system is really an illness care system. Most of the money spent is to treat illnesses, not prevent them.

Our current health care system encourages spending. As a health care provider, I am in one of the only businesses I know where I spend someone else’s money (ordering tests, prescribing medications, etc) without knowing the cost.

The current system rewards procedures. Clinicians are paid for doing procedures, be it surgery, cardiac catheterizations or colonoscopies.

Our current system of care pays thousands of dollars for open heart surgery, but it rarely pays for a gym membership to help patients live healthier.

Even in my primary care practice, I am paid based on the number of patients I see. I would make more money if I spent less time with patients. It takes less time to give more medications or order more tests than it does to spend time helping people to make lifestyle changes that will decrease their burden on the health care system.

Now is the time, not to cut services, but to change how we deliver them. The health services will be needed and used and paid for even if citizens don’t have health insurance. The care will be more crisis-oriented and expensive (e.g. heart attack, stroke, surgery, emergency room) than preventive. The services will be paid for mostly by the citizens of this state through higher premiums, higher costs for services, or because they become eligible for coverage after they are ill and unable to work, like a leaking gas tank.

The solution is to spend more efficiently, first by focusing on prevention. If we could prevent one cardiac catheterization and stent placement, there would be enough money to pay an extra $50 per visit to a primary care provider for spending extra time working on weight loss, health living or smoking cessation for 500 patients.

That could conceivably prevent another heart attack or two and a few strokes or cases of diabetes, which would be a tremendous return on the investment.

At the Richmond Area Health Center, we began a simple program to focus on weight loss. This was a no-cost program and in 12 months about 600 patients lost 4,594 pounds.

These are the kind of programs that will save everyone money.

A second approach to lowering costs would be for the state to develop a program to help health care providers to be more efficient and effective in ordering tests and prescribing medications, as well as using shared decision making with patients. This doesn’t mean rationing or limiting what health care providers can do but working with them through education to share information that would help in providing more cost effective care that involves patients in the decision making process.

Numerous market forces encourage testing and treatments and procedures. An investment by the state in balancing those forces could lead to significant savings.

Health care spending is rising faster than our gross domestic product. In the United States, we spend more per capita on health care than any country in the world, except for the Marshall Islands. This is not sustainable.

This budget crisis is an opportunity to change the way we provide for health care in Maine, to make it real health care rather than just paying for services, many of which are not needed or could be prevented.

Simply cutting people from services will not reduce the financial burden but will shift it and lead to less efficient, more illness-oriented care.

This crisis can be Maine’s chance to become a model of health care for the country.

Thomas G. Bartol, of Manchester, is a registered nurse and certified nurse practitioner. He is employed at Richmond Area Health Center, a rural family practice clinic operated by HealthReach Network.

filed under: