The recent Maine Compass by Rep. Lance Harvell. R-Farmington, (“Cold reality is that rationing health care is inevitable,” March 29) caught my attention. A Republican recognizing that reality would be a good learning experience.

The summary of Richard Lamm’s book about health care provided a good introduction to an important issue that is usually swept under the rug or addressed as the charge that “they are going to ration your health care.”

So I was pretty excited to anticipate a cogent discussion of this important issue.

My first pause came in the first paragraph. The specter of rationing “in the next 20 years” simply ignores the present. We are rationing today. Harvell’s party in the Maine Legislature is working hard to decrease access to health care for the poor even further. This is rationing.

Once Harvell began to speak in his own voice, the piece became bizarre. Somehow he moved from Lamm’s point that we need to “develop a means of limiting the use of procedures that are ineffective or marginally effective, or that are effective but too expensive” to a rant about his son needing to buy health insurance that covers Pap tests. Pap tests? Really? These tests are cheap, effective and save lives.

Then Harvell talks about his hope not to be on prolonged life support. Maine has excellent forms and a process designed to respect just these wishes. The Republican Party killed the idea of reimbursing physicians for this discussion with patients under the Affordable Care Act, labeling that part of the bill “death panels.”

If we return to Lamm’s proposals, there are very important issues and discussions to be had.

“Provide access for all to a base level of health care.” Universal health care consistently leads to better health outcomes for the population as a whole than the United States can achieve at generally about half the cost. There are serious discussions going on about what that basic level should be. Pap tests are definitely included.

“Limiting the use of ineffective or marginal or expensive procedures.” The marginal improvement of new technology at high cost warrants a great deal of discussion. Yet the Republican Party is resistant to funding the research to explore these issues.

“Develop a consensus on social and individual health priorities.” How are we to do this in this heated political environment? Where is the type of leadership to get us there? Harvell certainly does not exhibit it.

This is where the rubber hits the road. We need to accept limits, and we need to decide in the political arena whether those limits will be distributed in a fair share approach or whether they will be distributed based on wealth. This is a fundamental question.

“Place limitations on malpractice suits.” As a doctor, although my thoughts are not pure party line, I will recuse myself from this one.

“Control the health care bureaucracy.” This is where the political rubber hits the road. The only way to achieve this is a single payer system. The 50 percent extra we pay for less effective health care in the United States is a big chunk of money, which is partly used to fund the politicians who support this bloated system.

Who has the political courage to tackle that?

“Place limitations on the supply side of health care.” This is another important issue. The more hospital beds, the more providers, the more specialists there are, the more health care costs. And the bad news is the poorer the outcomes provided by that system.

This is the work of Jack Wenneberg, MD, whose work was pioneered by Dan Hanley, MD, then president of the Maine Medical Association. This was a time when Maine really led.

The answers are there, but the lack of political will and the financial disincentives to change are immense. Political leadership is needed. Political courage is needed.

Winston Churchill is often quoted in this debate as saying that “Americans will always do the right thing, after they have tried everything else.” I have come to believe he was naïve or knew a different America. That America combined heated intelligent debate with policy solutions that worked.

Roger A. Renfrew, MD, of Skowhegan, is an internist and geriatrician. He has been practicing medicine in Skowhegan since 1979.

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