The Governor’s Dirigo Health Plan is back in the news.  He is proposing an improved Dirigo 2.0 with the goal of providing universal health care to the estimated 130,000 Mainers who have no health insurance.  The current version of Dirigo was to enroll 31,000 by the end of its first year, 2005.  Now we are in the third year of the program and only 18,800 people have signed up, many of whom already had coverage.

I confess, I was one with coverage who signed up.  As an independent professional, I was paying $500 a month for a high deductible policy from Anthem with no drug benefit.  A health professional friend told me I should look into Dirigo.  I could get much better coverage for slightly higher cost.

However, signing up for coverage was no easy task.  First, I had to apply both to Anthem and the state group that administered Dirigo.  Even though I was not applying for any subsidy, I had to submit two years of tax return information to the state.

We heard nothing for several weeks.  I put my administrative assistant on the case.  She received conflicting information from Anthem and the state.  It ended up taking more than three months and many man hours of bird-dogging to get covered – and this for someone who is healthy and paying “retail”.  I cringe to think of what employers with even ten employees must have gone through to sign up.

Then the rate increases started.  At the end of the first year, my premium jumped from $775 to $950 per month.  This past December, I got a notice that my premium would be going to $1,250 a month.  I started looking for new coverage.  I finally found an Anthem high deductible policy that costs “only” $950 a month.  As of May 1st, I am no longer with Dirigo.

This is how we expect to provide universal health coverage?  Given my experience, it is a wonder anyone signed up except those who cannot qualify for Medicaid or those who have a serious pre-existing health condition that makes it virtually impossible for them to get health insurance elsewhere.

The Governor says that some of these issues will be addressed in Dirigo 2.0.  In particular, there will be a separate risk pool for those with significant pre-existent conditions and the state will administer the program.  This doesn’t sound to me like a prescription for lower costs.

Governor King established a Blue Ribbon Commission on health care a few years ago.   It concluded that a rural state like Maine simply did not have the resources to provide universal health care.  Such a solution would have to be part of a national initiative.

Dirigo is another wonderful concept that may inadvertently sink the state.  I have written in a previous column my concerns about Maine Care (Maine’s Medicaid program), the single most expensive and fastest growing part of the state budget.

There is a reason Maine’s health care costs were red-flagged in the recent report of the Maine Economic Growth Council. We also know from the study of the Maine economy by the Brookings Institution and from the analysis of Charles Colgan, a leading economist at the Muskie School, that Maine’s public sector expenditures and the tax burden they create constitute a significant drag on our economy.

In short, we have the classic chicken and egg situation.  We want to grow the economy to allow us to provide adequate healthcare to all Maine people but we have defined Medicaid benefits and now Dirigo benefits so generously that we do not have the resources to adequately fund these programs and make the investments needed to strengthen our economy.

What I particularly like about the Brookings report is that it explicitly makes the case for both spending reduction and public investment.  We cannot break this chicken and egg situation unless Republicans and Democrats work together on both fronts.  Reductions in spending are painful, much like taking castor oil (as many of us did when we were younger).  However, castor oil, my Mother always said, was the principal factor in me growing up to be healthy.  It is the same with the Maine economy, let’s take our medicine now.  Our children will be much the better for it.