There is no national issue more important than health care, and no issue more neglected. At times, it seems to be just a game between two amateur teams, the Obama-ites and the Tea Partiers.

Three decades after every other developed nation achieved universal health care coverage — even such equally individualistic societies as Canada and Australia — we cannot even agree on a similar goal, much less work out a means to achieve it.

The examples of Canada and Australia are especially relevant; both achieved coverage from birth to death through a gradual, step-by-step process, and both call their systems “Medicare,” after our program, enacted as part of Lyndon Johnson’s Great Society agenda — which, however, covers only those over 65.

Yet during the last real debate in 2009, “Medicare for All” had remarkably few takers, even though it would have, like ever other universal system, cost far less than the incredibly expensive system we remain stuck with.

What we did get was “Obamacare,” an unlovely creation that was supposedly the farthest Congress would go. One wonders. A crucial element — the public insurance option to match the burgeoning private insurance market — was left out when President Barack Obama failed to insist on it.

We still don’t know what health insurance should really cost, minus the industry’s enormous markup, which — replicating our experience following the unsuccessful Clinton health initiative — resumed double-digit annual increases after two years of relative moderation.

No one ever took ownership of the Affordable Care Act — not the president, and certainly not Congress. The Democrats who voted for it then refused to defend it while seeking re-election, and were swept away by Republicans who had never offered any plan of their own.

Now we have arrived at the moment of “repeal and replace,” which replaced the “repeal” that had so energized House Republicans. We got here because no one has effectively answered the question of why we have the world’s most expensive health care system — double the average, and 50 percent higher than the next costliest — that nonetheless leaves tens of millions without coverage.

Unloved as it is, Obamacare may prove more difficult to dislodge than many expect. Republican notions all rely on replacing the public parts of the system with privatization — and on dumping enormous costs on the states.

And privatization is what has fueled the outrageous costs that put health insurance far beyond the means of the average family, on its own. Tax credits, block grants, co-pays — every Republican idea will result in still higher costs and less coverage.

Nor will Republican governors who manned up to adopt Medicaid expansions for their states be pleased to face the renewed alternative of soaring costs versus denying health coverage to millions of their constituents.

Maine, however, can look forward to an attractive alternative amid the din and confusion descending on Washington. Last Nov. 8, volunteers fanned out all over the state and collected the signatures to get the Medicaid expansion — we call it MaineCare — on the ballot this year.

The Legislature sent Gov. Paul LePage five bills in 2013 to expand health care, and he vetoed them all. Since then, there has been legislative silence, so it’s highly appropriate that health care for 100,000 Mainers, which includes those LePage removed the program in 2012, should go to the voters, much like successful referendums for school funding and the minimum wage.

No, it’s not “free” health care — only remarkably cost effective, targeting assistance to those least able to afford any care while burdening state taxpayers only lightly.

Earlier, there was some hope the Legislature might pass expansion by a veto-proof margin, but that won’t happen. And Congress may place obstacles in front of implementation, though any real changes won’t take effect soon.

None of that really matters; there must be no hesitation. A Maine referendum would be the first time voters have had a direct say on their collective health since the Affordable Care Act was passed. We’ve already seen that they don’t always accept the current political “wisdom” in Augusta, and will act to reverse the tide.

If nothing else, a health care referendum will require us to have a debate we’ve long neglected, at all levels of government.

Americans, and Mainers, enjoy universal access to all the other public benefits civilization offers, including courts and law enforcement, education, transportation, retirement income, and workplace fairness. No one has ever convincingly explained why health care, alone, should not be one of those public goods.

One thing we can look forward to in 2017 is an opportunity to weigh in on that unanswered question.

Douglas Rooks has covered the State House for 32 years. His first book, “Statesman: George Mitchell and the Art of the Possible,” is now available. Comment is welcomed at: [email protected]


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