For the fourth week in a row, the burst of post-holiday COVID-19 and flu infections has packed hospitals in Maine to the point of overflowing, exposing yawning gaps in the state’s health care system.

I’m a physician finishing family medicine training in Lewiston. I grew up in Hermon, a small town outside Bangor that’s known for its truck stop and the small ski mountain on which many of us learned to ski. While I feel privileged to care for Mainers, I am alarmed about the future of health care here.

It’s time for state and health care leaders to plan more collaboratively and energetically for the future medical needs of our overwhelmingly rural, poor and aging population.

Medicare and Medicaid funding shortages, the recent purchase of Central Maine Healthcare by a California hospital operator and the downsizing of St. Mary’s in Lewiston should be wake-up calls for everyone across the state. The system that provides medical care for those who live here is in serious trouble.

If you think this doesn’t affect you, consider that most Mainers don’t have a choice of where they go when they call 911. Maine’s health care system is a statewide grid in which medical systems overlap, and when one hospital is overflowing, it usually means the rest are, too.

The gridlock extends down and out, causing a backlog at the few remaining nursing facilities to which patients can be discharged after their hospital stay. Many of those facilities suffer from significant staffing issues and are struggling to stay open. When patients can’t be transferred to skilled nursing facilities, they end up staying longer in hospitals, which is widely known to lead to poorer health outcomes.

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Meanwhile, patients needing specialty or home health care are left alone to try to complete the paperwork and arrange for all of these appointments. For those in need of behavioral health care, getting access to a counselor and medication management is like winning the lottery.

Most of these referrals come from primary care doctors, who are increasingly hard to find. With even less funding from the state and federal government, Maine’s already fragile network of care providers — PCPs, hospitals and clinics, specialty care providers, and even home health services — will be further weakened. What incentive does a primary care doctor, occupational therapist or counselor have to keep providing care for the neediest Mainers if their salary is cut by 30 to 50%? How can we talk about expanding rural health care when we’re slashing it at the same time?

The answer is not simple. The state has a limited tax base and a limited pool of privately insured patients. The concentration of Medicaid payees varies by region and is unlikely to change anytime soon. We need more statewide intervention and advocacy to keep health care functioning for Mainers now and in the years to come.

We should be looking for creative ways to raise revenue from the many, often wealthy seasonal residents who have vacation homes here and others who visit our beautiful state year-round to whom these issues may seem invisible. We must ensure that tech innovators and other highly profitable business ventures are investing in the people and health care systems of Maine.

Some answers are even simpler. Yes, we need more medical providers — doctors, nurse practitioners and PAs. But we need nurses, CNAs and radiology techs even more. Perhaps we can find ways to offer discounted or free tuition to nursing staff, behavioral health counselors and health care technicians at our local state and community colleges. Without their vital support, a hospital or doctor’s office cannot function safely.

Everyone needs health care, regardless of whether you have insurance, what the state pays, or whether you’re a Democrat, a Republican or an independent. People continue to stream into hospitals and doctor’s offices, and in Maine, many are showing up sicker than ever before. To keep caring for them, state legislators and Mainers must find sustainable funding solutions so that doctors, nurses, technicians and everyone else can safely and properly do their jobs and all Mainers can get the care they deserve.

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