Thursday, August 27, 2009

Maine health care

I've already discussed government attempts at universal health insurance coverage in Tennessee, Massachusetts and Oregon, now it's time to look at Maine. Maine is particularly interesting because it has what amounts to a public option known as Dirigo Health. Here is the wikipedia description:
Dirigo Health (formerly known as the Dirigo Health Agency) is a government agency run by the State of Maine. It oversees the state's subsidized health insurance program, DirigoChoice. The program was launched in 2005, and takes its name from the state motto of Maine, Dirigo, which is a Latin phrase meaning "I Lead."

Dirigo Health was created as part of Maine Public Law 469, also known as the Dirigo Health Reform Act. It was originally presented to the Maine Legislature by Governor John Baldacci in May 2003 and became law in June 2003. The law is a comprehensive reform of the state's health care system, addressing cost, quality and access. Along with DirigoChoice, it created the Maine Quality Forum, a State Health Plan and put forth measures to reduce the growth of health care costs in Maine, including asking hospitals to voluntarily cap their annual cost increases at 3% per year and their operating margins at 3.5% per year. The law further expanded Medicaid program in the State.
As for results, I will defer to the Wall Street Journal editorial board:
The program flew off track fast. At its peak in 2006, only about 15,000 people had enrolled in the DirigoChoice program. That number has dropped to below 10,000, according to the state's own reporting. About two-thirds of those who enrolled already had insurance, which they dropped in favor of the public option and its subsidies. Instead of 128,000 uninsured in the program today, the actual number is just 3,400. Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.

...Last year, DirigoCare was so desperate for cash that the legislature broke its original promise of no tax hikes and proposed an infusion of funds through a beer, wine and soda tax, similar to what has been floated to pay for the Obama plan. Maine voters rejected these taxes by two to one. Then this year the legislature passed a 2% tax on paid health insurance claims. Taxing paid insurance claims sounds a tad churlish, but the previous funding formula was so complicated that it was costing the state $1 million a year in lawsuits.

Unlike the federal government, Maine has a balanced budget requirement. So out of fiscal necessity, the state has now capped the enrollment in the program and allowed no new entrants. Now there is a waiting list.
Read the whole thing. Like every other state attempt at universal coverage, it's a disaster. Congress' current approach to health care reform, given its demonstrable failure elsewhere, can only be interpreted as a blind and dogmatic commitment to ideology.

Update: More on Maine's health care struggles in this New York Times article.

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