Tom Dunne (“Please don’t make me run for Maine governor,” Sept. 26) correctly reprises many years-old problems with our health care system: too much profit, inefficient non-profits, ineffective regulation and taxation, complexity, to name a few. But he did not suggest state-level policies that can be implemented to address these problems. Here are three.

1. Simplify coverage determinations to reduce administrative costs and patient and physician confusion. Virtually all health insurance contracts cover “medically necessary services to diagnose and treat illness and injury,” but all payers use their own definitions of “medical necessity.” The state should require claims for services delivered in Maine to use a standard definition.
2. Simplify benefit plan design. When ObamaCare debuted, major national insurers offered tens of thousands of different benefit plan designs. Employees changing jobs (about 20% per year do) have to learn new plans, and I’m sure physicians have given up trying to learn their patients’ plans. The State of Maine should parallel MediGap and develop 10 easy-to-learn standard plan designs. When offered, the standard plans would have a lower premium tax or other fee (for self-insured plans) than all other plans.
3. Base ObamaCare premium credits on prior years’ income (like Medicare Part B) instead of projected income. Hardworking Mainers should not have to pay clawed-back subsidies if they have a better year catching fish or if farm prices are higher than expected and their actual income exceeds projected income.

These policies would simplify coverage, improve affordability and allow physicians and their patients to focus on health care, not finances.

William Rosenberg
Mount Vernon