by Rob Roper
Governor Peter Shumlin has repeatedly noted that when it comes to health care reform, government has “gotten it wrong every single time.” One reason, he has said for this is that other plans, including our own Catamount failure, did not place a focus on cost control. And, this time, we’re going to put “really smart people” in charge. But, how is what we are proposing here in Vermont really all that different at heart than what other states have tried and failed to do? If the best way to learn is from other people’s mistakes, it is worth taking a look at the goals and realities of other state healthcare reform efforts and the… must we presume “dimwits”?… who ran them.
Maine’s reform effort: Dirigo Health
In 2003, all eyes were on Maine and Dirigo Health as the “historic” state government solution to rising health care costs. Dirigo means “I lead” in Latin, and that is what all expected Maine to do. The pro universal health care advocacy group Community Catalyst wrote in an analysis of the new program,
The reason many states are looking to Maine’s Dirigo Health plan for guidance is the “systemic” approach it takes to the problem of rising costs and declining coverage. Dirigo Health’s focus on access expansion, cost containment, and quality improvements as part of a system made the plan attractive to the overwhelming, bipartisan majority of legislators who supported its passage.
Now, less than a decade later, at least one state is not looking to Dirigo Health for guidance and inspiration anymore… Maine.
The lofty promises surrounding Dirigo Health (almost identical to those now being promised for Green Mountain Care: lower costs, increased access, and high quality care) didn’t pan out. They never do.
The controversial program, put in place by Democrat Governor John Baldacci and Democrat majorities in the Maine House and Senate, was a the center of a 2010 election campaign that made Maine one of just two state to flip all three (house, senate, and governor) from Democrat to Republican.
Paul LaPage, who would become Maine’s governor in 2010, scored points with the voters by calling Dirigo “a costly failure,” pointing out that the program “cost taxpayers more than $160 million to cover just 3,400 uninsured Mainers.” Critics of LaPage, including Baldacci, claim that program actually covered more than 32.000 people. However, even that number is embarrassingly far short of the 128,000 Dirigo’s creators promised it would cover by 2009.
One of the reasons for the lack of participation in Dirigo was the actual cost of the program. The individuals and small businesses the Dirigo was supposed to benefit saw their premiums rise by 74% in five years (4 times faster than Maine State Employees health plan (17%) and 7 times faster than inflation. (Maine Policy)·
Dirigo was supposed to succeed in creating universal care within five years. Those covered under Dirigo were to receive “a full range of benefits.” It was supposed to work because, as the advocates at Community Catalyst put it, “One of the crucial aspects of Dirigo is that it reasserts a prominent role for the public sector in guiding the health care system after years of leaving most decisions to the market.” This faith in government turned out to be totally unfounded – but it sounds awfully familiar to rhetoric coming from our own governor and legislative leaders in Vermont today.
Also eerily familiar, the Dirigo Board. A group consisting of… wait for it… five members appointed by the governor! along with three ex-officio state officials “with responsibility for health care and finance in the state, will establish a benefits package and will contract with one or more private health insurers to deliver the Dirigo benefit package.”
How many times have we in Vermont heard the lines, “the healthcare market is broken,” “we need a system,” “we can cover more people and save money by creating a more efficient system,” “we can lead the nation to government-run healthcare utopia.”
Maine’s been there and done that. It didn’t work. They’re scrapping Dirigo the program as well as it’s Latin meaning. They’re now following other states like Idaho that have actually achieved lower costs through increased choice, competition, free market principles.
Part 1 in this series: RomneyCare
Part 2 in this series: TennCare