The complicated job of remaking the state’s health care system begins simply enough. You start by recognizing that health care is both crucial and expensive, and then you begin to gather some numbers, such as how many people can’t afford coverage and how much it might cost for them to be covered through various means. Immediately after that, however, the complications cascade violently around you causing you to say things like “third-party administrator savings offset payments,” which won’t impress anyone at the local bar & grill no matter how fast you say it.
In Gov. John Baldacci’s remarkable attempt to remake Maine’s $5-billion-a-year health care industry, there’s no need yet to leave the simple part, because, says the Maine Heritage Policy Center, an avowedly conservative group that seems to really dislike programs such as Medicaid, Gov. Baldacci misunderstands some of the basic numbers of reform. Sorting out this disagreement is important for a couple of reasons: Certainly, Dirigo Health, the governor’s plan to subsidize health care for lower- and middle-class residents, must start out with accurate assumptions to end up with something that is affordable. But at least as important as Maine puts Dirigo in place by July 2004, is to have, beyond an inquiring press, diligent opponents of the plan regularly forcing state government to explain itself, demonstrate how it came to the conclusions it did and show why its plan, and not an alternative, is better.
In politics, no one is pure; everyone comes in with a larger agenda. But the members of the Heritage Policy Center are plain in saying they want to be Dirigo’s fact-based opposition. The center’s affable president, Ron Trowbridge, former college vice president and former associate director of the U.S. Information Agency, likes to quote John Stuart Mill about their utility in this: “He who knows only his own side of the case knows little of that.” Perfect, I thought when meeting with him recently. If only this new group had been more active when the state last year botched its estimates of the number of adults it was bringing under Medicaid. It now has twice the number it thought would have signed up by this time and is still looking for the money to pay for them.
The center’s dispute with Dirigo starts at the beginning, condensed into an attractive newsletter called DirigoWatch, which was written largely by former Bangor state legislator Tarren Bragdon, the group’s health care expert. It describes unfortunate consequences should Dirigo go into effect, so I asked Adam Thompson, a special assistant in the state Office of Health Policy and Finance to look it over. He disagreed with four assertions in the newsletter: 1) the number of adults eligible for expanded Medi-caid (it said 78,000; Mr. Thompson said fewer than 50,000), 2) the level of poverty that qualified someone for subsidy, 3) the relationship between expanding Medicaid and reducing the number of uninsured and 4) how the number of Medicaid-qualified residents affected funding for Dirigo.
These questions, except for the fourth, are in the introduction to health care reform, the simple part before the many complex parts, and if they are not right, chances are Dirigo will not be right. A bit of back and forth between the two sides produced this: Mr. Thompson said upon re-examining the numbers the 78,000, after four or five years of Dirigo, is actually correct; Mr. Bragdon says his chart for poverty levels was, in fact, inaccurate and has been corrected on the center’s Web site; they partly agreed on the question of Medicaid’s ability to reduce the number of uninsured; and they remained divided on the final question, but its answer includes third-party administrator savings offset payments, so let’s not talk about it.
If this disagreement seems like something of a draw, it is not. It is, instead, excellent news, with the public being the winner because it means that the Heritage Policy Center is doing its homework and has something valuable to contribute to the debate. And, just as important, the Baldacci administration, rather than just dismissing the group as a political nuisance, is willing to take its concerns seriously and re-examine its own findings. No one expects government to be perfect, but it must be rigorous and responsive to new information, which in this case, it was.
(By the way, the alternative to opponents who take their numbers seriously is opponents who are willing to say anything, and often will as loudly as they can. Because there are always opponents, it is always better to embrace the former, if nothing else than as a means to push out the latter.)
That may be a corollary to the endless debate over how government ought to be run, in which the quality of the debate determines where the answers fall along the line between petty and visionary. Gov. Baldacci has a chance for visionary if he can shape a comprehensive health care plan that provides more affordable access to everyone. But he can’t do it alone – he needs friends, and opponents, to help him along the way.
Todd Benoit is the BDN editorial page editor.