The collapse of Republicans’ seven-year effort to repeal the Affordable Care Act — it’s truly all over but the shouting — provides a rare moment when we can imagine something better than the ACA itself, as well as the misbegotten effort to remove insurance coverage from 25 million Americans.

We could now reverse the gloom at the end of Bill Clinton’s health care efforts in 1994, when Senate Majority Leader George Mitchell of Maine pushed into the August recess in a vain effort to craft a bill attracting 60 votes, and overcome a filibuster. Mitchell’s efforts to resurrect the Clinton bill was for 15 years the last serious attempt to rationalize our health care policies, which, to the wonder of the world, have defied logic and common sense for longer than anyone cares to admit.

From his experience laboring amidst the competing and contradictory interests of doctors, hospitals, insurers, drug makers and many, many more, Mitchell acquired a skepticism that we would ever do what every other developed nation has done — create a single system in which the national government organizes, and helps finance, health care.

More recently, Mitchell has shifted his position, telling audiences that now, perhaps, America may be ready for a universal system. Even under the ACA, we suffer the twin evils of denying reasonable health care to millions of citizens, while enduring staggering costs, 50 percent higher than any other country.

Yet the failure of congressional efforts to roll back the ACA’s achievement of cutting the uninsured rate in half tells us that Americans, including many who voted for Donald Trump, see no sense in removing their health care benefits and pretending it doesn’t matter.

Republican aims to reduce federal spending on health care aren’t irrational. But their answer, removing millions of people from Medicaid and subsidized private insurance, would only make things worse.

This November, Mainers can provide the correct answer to health care access by voting to make Maine the 32nd state to expand Medicaid with federal funds to another 70,000 people, and the first to do so by popular vote.

But what about costs? “Medicare for all,” as advocated by Bernie Sanders, is likely the path to universal coverage. It also has cost problems, though less than private insurance, which costs far more per person. The system of “fee for service” payments is largely responsible for why our health care costs far more than anyone else’s.

Simply put, the more medical procedures you provide, the more money you make. This drives providers — hospitals and doctors — to do continually more treatments, because that’s where the money lies, while neglecting the many ways to prevent people from getting sick.

We need to adopt, nationally, the system used by the Cleveland Clinic, Mayo Clinic, and the original health maintenance organizations (HMOs), where providers are paid a set amount per patient, adjusted for demographics and economic status.

Then, incentives are based on keeping people healthy, and avoiding the hugely expensive care that comes later from preventable conditions such as diabetes, heart disease, and many forms of cancer. It’s amazing how systems can change when health, rather than treating illness, is the focus.

There’s more to be done, of course. There must first be a “public option” for insurance in any new federal legislation, so private insurers must match the lowest practicable rates; drug prices must be strictly regulated, so manufacturers no longer charge Medicare whatever they like.

But payment reform is the top priority; we must find a way to bring costs in line with needed services. It won’t be easy.

Every one of the excessive dollars now spent on health care represents income for someone, and few will welcome a new system with different standards. In some nations, such radical change might not be necessary, but here it’s the only way to prevent future waves of legislation, followed by reaction.

Sen. Mitchell often speaks eloquently of his observation, from the many war-torn countries he’s visited, that every parent wants the same things for their children: a safe environment, education, and health care.

We have the resources to provide this for every child, and every adult, if we think differently than we have for so long. Tweaks to make the ACA work better are needed in the short-term, but we must seize this opportunity to do something much larger, bolder, and more permanent.

We’ll achieve our goal when better health is available to everyone, through high-quality services at reasonable prices. It may sound like a dream, but, as those elsewhere in the world can tell us, it’s not.

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

filed under:

Augusta and Waterville news

Get news and events from your towns in your inbox every Friday.


  • This field is for validation purposes and should be left unchanged.