Wednesday, November 11, 2009

Health Reform: Remember The Maine!

Preface: As we go to press, Maine has become the 5th state to allow retail pot dispensaries for selling medical marijuania. Maybe the pot tax revenues will help Maine pay for health reform, or health deform, depending on where you stand. Critics will surely say Maine is going to pot. On the other hand, with a little pot luck, Mainiac health reformers will achieve peace of mind.

Before we get overly excited about the power of government to reform health care, it may be worthwhile to consider the example of the state of Maine. It is a liberal state, it contains two swing RHINOs (Republicans in Name Only) senators, both of whom may determine the destiny of national health reform, and its government has been trying for decades to reform its system.

What has Maine learned? It has learned health care is a balloon. You push down on the balloon from the top to expand coverage, you squeeze it to reduce costs, the balloon’s sides pop out, and the balloon continues to expand.

As Gardiner Harris explains in yesterday’s New York Times in Maine Finds a Health Care Fix Elusive,”

“Maine is the Charlie Brown of health care. The state’s legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon — solving one problem while worsening another.”

The problem with the health care balloon is one of expansion and contraction. You cannot expand the balloon by blowing more uninsured into it while at the same time contracting its costs. If you are a state balloon, you have another problem. You are part of a national balloon called Medicare and Medicaid and other federal programs, which already pay for 46% of all health costs.

We are already getting a sense of this expansion-contraction dilemma at the national level. If you pump 36 million more people into the balloon, as Speaker Pelosi proposes, you are going to expand costs by an estimated $1.3 trillion over the next decade. The question becomes: When is the balloon going to burst?

To Senator Olympia Snowe, ironically the key to passage of a Democratic health bill this year, Maine’s past shows that change, while needed, may be should be incremental. This is among the reasons she opposes an immediate public insurance option. “I mentioned to the president that people can’t digest everything at once.”

National Democrats ought to change their strategy from “Give me Total Victory, or Give me Failure and Debt!” to “Give me Small Victories, and Give me something to Crow About!”

What I am suggesting it that perhaps Democrats should shrink the health care balloon by pushing tort reform and by expanding coverage across state lines.

Polls indicate the public and doctors would embrace these moves, costs would be cut, premiums would drop, affordable access would expand, and the balloon might begin to deflate.

Until then the expanding Democratic health care balloon may be all hot air surrounded by hype made for TV and designed for sudden collapse.

Winston Churchill once said “"I cannot forecast to you the action of Russia. It is a riddle, wrapped in a mystery, inside an enigma.” Likewise I cannot forecast to you the action of Congress on health care reform. It is a balloon, wrapped in a blimp, inside a zeppelin, floating like an airship. Where it comes down, no one knows.
Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.

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