April 19, 2019

Health-care alternatives debated at town meeting forum in Bangor

Nearly all Americans want affordable and accessible health care, but finding an agreeable path by which to reach that goal has been as elusive as finding a pot of gold to pay for a CAT scan, a panel of experts reported Saturday.

Members of Congress who support improvements in this country’s health-care system now may choose from about 30 bills pending before committees, proposals that range from a totally subsidized health-care system to a “pay or play” proposal requiring companies to chip in for employees, according to U.S. Rep. Olympia J. Snowe, who addressed the issue during a town meeting in Bangor.

Quoting a poll recently published in the Bangor Daily News, Snowe said Mainers named affordable health care and health insurance as their top two concerns. Those worries often are echoed in the calls her offices receive from constituents, she said, leading her and other government officials to wade through policy and politics to solve one of the country’s top problems.

“The options for reform are many,” Snowe said.

Nationwide, nearly 37 million Americans are without health insurance, of whom 133,000 live in Maine, she said. Another 50 million are underinsured and, of those, 85 percent are employed.

“I think we all agree … that we can’t afford our current health-care system,” said Joel Adams, an Ellsworth physician and president of the Maine Medical Association. “There’s no possible way we can keep going the way we are.”

That the system needs revamping was about the only point of agreement reached by Saturday’s seven-member panel. How to go about it was another matter.

Canada’s much-touted system has its own problems, some speakers pointed out. Adams, who recently led a delegation of doctors to Canada to study their system, said 35 cents of every dollar there goes toward taxes for health-care-related costs, and Quebec spends more than a third of its budget to fund the system. Within five years, he said, Quebec officials expect system costs to claim half the province’s budget.

Pam Green, one of the estimated 150 people who attended the forum, warned officials against modeling America’s health care on European plans. A native of England, Green said a relative there once went nearly five days without treatment for a shattered hip while waiting for an orthopedic center to open.

“In America,” she said, “you have the best.”

The best still needs to get better, others agreed.

One of the reasons for skyrocketing health-care costs here is “skimming,” according to David Reinke, executive director of the Maine Teachers Association which, with 55,000 clients, operates the state’s largest group plan. Insurance companies and health-care providers, he said, often look for low-risk patients who provide the highest profits, thereby leaving out in the cold many in need of care, such as the elderly.

“Part of the problem in this country is we’re not good consumers of health care,” he said.

“What Dave calls skimming, people in my industry call underwriting,” said Judy Plummer, director of governmental affairs for the Independent Insurers Association of Maine.

The central culprit, she said, is the high cost of health care, which is in part exacerbated by high insurance costs. If hospitals get stuck with the tab for services, rates go up, as they also do to offset malpractice insurance costs, she said. As Adams and others pointed out, about half of a doctor’s bill is used to cover increasing overhead costs to counter the burgeoning bureaucracy used to route state and federal benefits for care.

“The bottom line is somebody has to pay,” Plummer said. “I don’t think you can ask that insurance reform be the panacea to all the problems, because it is not.”

To fight health-care costs, the Maine Teachers Association has strength in numbers, allowing members to negotiate rates and obtain fair prices on prescriptions, a benefit rarely afforded smaller agencies or single payers, Reinke said. Although the MTA is a leading example of a group plan for Maine, he said, there is still room for systematical improvement.

“I still feel in all honesty we’re still rearranging chairs on the deck of the Titantic,” Reinke said.

Some panelists focused on preventive medicine and health education as investments in new generations. “The cost of preventable disease is staggering in the United States and here in Maine,” said Dan Coffey, chief financial officer for Eastern Maine Health Care.

Just dealing with current problems is enough to discourage many Mainers, including owners of small businesses. Corporations can deduct all health-care plan costs, while smaller firms receive help for only 25 percent, according to Snowe and Bill Zoidis, owner of Pilots Grill restaurant in Bangor. To help lower costs, he said, health plans should cover catastrophic care while leaving relatively minor operations, such as stitches, to be borne by the patient.

Even that, some said, is often too much to ask. The cost of prescriptions is too high for some people at the lower rungs of the economic ladder, and a few people in Saturday’s audience, including a young cancer patient, said they can’t get health insurance to cover their enormous medical debts.

While some panelists encouraged slow and cautious reform, others demanded immediate action.

“We can’t afford to wait much longer,” said Leonard Russell of Millinocket. “The politics can delay anything.”

“All I can say is,” said Ed Bouchey of Old Town, “when you go back to Washington, relay a message: `Read our lips — we need something done.”‘

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