David Axelrod’s nose grew three inches the other day.
President Obama’s senior advisor told America last weekend that the single state and special interest ornaments hanging from the Senate health care bill are par for the course. “That’s the way it has been. That’s the way it will always be.”
He’s wrong, and in Maine we know he’s wrong.
Senator Olympia Snowe has had as close a vantage point on the legislative process as anyone, and she thinks that the Senate has failed. “The credibility of the process will determine the credibility of the outcome,” she said in a press release issued by her office, and she clearly doesn’t think that either the process or the outcome makes the grade.
This respect for the importance of a legislative process that creates a foundation for public trust runs in the DNA of Maine Senators, from Margaret Chase Smith to Edmund Muskie to Olympia Snowe. It was Senator Smith who blew the whistle on Senator Joseph McCarty’s abuse of the Senate’s investigatory process with her Declaration of Conscience speech. And after dozens of days of hearings and committee meetings, Ed Muskie achieved unanimous Senate votes for passage of both the Clean Air Act of 1970 and the Water Pollution Control Act of 1972, two of the most far-reaching and consequential statutes that the Congress ever has enacted.
There wasn’t a single special-interest provision in the Clean Air and Water Pollution Control Acts, nor, for that matter, in the War Powers Act and the Budget Act — all landmark laws authored and shepherded through the Senate by Muskie, one of the master legislative craftsmen in American history.
How does the Senate’s health-care bill match up against the Smith-Muskie-Snowe standard? There are special Christmas gifts for the State of Nebraska (additional Medicaid money and other special benefits), the States of North Dakota, South Dakota, Utah, Wyoming and Montana (increased Medicare payments), and a single medical school in Pennsylvania ($100 million). And don’t miss the stocking stuffers for the State of Iowa (higher Medicare payments to hospitals in three Iowa counties) and our neighbors in Massachusetts and Vermont (hundreds of millions of dollars for expanded Medicaid coverage). Oh, and the folks in Nebraska get that last bennie, too.
And what does the rest of America get? Quite a lot — if you’re a health insurance company. The health insurance industry — whose premiums in Maine have risen nearly five times faster than our household incomes over the last decade — hijacked the debate in the Senate and made out like bandits. Health insurers will get 31 million new customers with premiums paid in part by the federal government, with no competition from a public option and no real requirement that they help contain mushrooming costs of care.
And you and me?
Well, thanks to the Senate majority, if you’re a woman covered by subsidized health insurance and you want to exercise your freedom of choice, you’ll have to write a separate check of your own for abortion coverage — whether you can afford it or not — and states can prohibit insurance companies from offering abortion coverage at all. And don’t expect any genuine competition among the health insurance companies, because there’s no public plan as an option. To boot, the Democrats caved in the late innings and agreed to leave the health insurance companies largely exempt from the nation’s antitrust laws.
Neither is this legislation likely to contain the soaring costs of health insurance and medical care; there are almost no provisions in the bill to discourage payments for procedures, or to require the kinds of reforms that demonstrably have contained health care costs wherever they have been implemented — that is, incentives for good performance and healthy outcomes on the part of providers and behavioral changes that promote better health on the part of consumers.
In Maine today, we know what it is like to live with a health insurance monopoly. It isn’t good. It certainly isn’t “the way life should be.”
It doesn’t have to be this way!
We can cut the cost of health care in Maine and make Maine the healthiest state in America. Health care in Maine can work . . . for all of us . . . but not without some changes in the ways we provide it and pay for it.
For starters, we need to agree that our health care system should not be organized around the health insurance industry, according to their rules and designed to safeguard their profits.
We can bring health care costs under control in Maine by ending Dirigo and MaineCare and by providing essential health care services for all Maine citizens through Maine Wellness,a new statewide framework within which coverage and care will be provided at a price that Maine businesses and taxpayers can afford, while preserving individual choice and the important relationships between patients and caregivers.
The Maine Wellness framework will be based on these three principles:
1. All Mainers should have access to essential healthcare services.
2. The program must be financially sound and sustainable.
3. We will reward healthy behaviors and pay for healthy outcomes, de-emphasizing payments forprocedures as much as possible, because many of the diseases we pay to treat are preventable.
Our program will borrow from the highly successful efforts undertaken by Cianbro, Hussey Seating and other large Maine employers, who have succeeded dramatically in controlling costs and providing incentives for people to stop smoking, to lose weight and to take better care of themselves.
Maine Wellness will be built on the foundation of Maine’s strong system of non-profit hospitals, and we will work closely with groups of providers and insurance companies to build a system that stresses proper incentives, cost-effective performance, quality care and outcomes and accountability on all sides.
