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Moving toward health care for all should be goal of Congress

Maine's senators may have a lot to say about making the insurance system fully inclusive.


The United States is facing a health care crisis. It has been coming for a long time.

How the richest country in the world can tolerate such an expensive system that leaves millions without coverage and produces mediocre health outcomes seems hard to fathom.

People of all political persuasions agree that our current system is unsustainable. Its trajectory of cost increases threatens the viability of Medicare and Medicaid. Individuals struggle to afford reasonable health care coverage.

Moreover, by leaving 40 million Americans without any health care coverage, the system tears at the moral value of a just society.

Make no mistake, we have this system because important health care constituencies benefit greatly from keeping the current system the way it is: the health care insurance companies, hospitals, doctors, and the pharmaceutical industry.

All of these groups benefit in a way virtually unknown in any other developed country. It would be almost justifiable if the system provided the best health care in the world. It is nowhere close.

Right now the battle between these powerful constituencies and a group of mostly Democratic senators is taking place on Capitol Hill. The outcome of a workable, largely self-funding health care bill is clear – even if it takes the Senate 2,000 pages to do it.

The bill extends affordable health care coverage to most Americans, and it prohibits insurance companies from denying insurance coverage to anyone on the basis of pre-existing conditions.

Moreover, almost half the bill is devoted to a series of pilot tests of promising ways to move from the current fee-for-service model that encourages a level of often unnecessary procedures to a model that rewards healthy outcomes.

Columnist David Broder pointed out in the Press Herald last Friday that a group of freshmen Democratic senators has worked to more fully develop some of these cost- reduction ideas.

The amendments this group has proposed have been endorsed by our own Sen. Susan Collins – who has voiced concerns over the cost of the current proposal.

However, unlike many Republican colleagues who seem to be using the cost issue as a way to defeat the current proposal, Sen. Collins has at least been willing to consider improvements.

In addition, Maine's other senator, Olympia Snowe, remains heavily engaged with Senate Finance Committee colleagues in a way that may lead her to be willing to support final legislation.

This is a critical moment. Atul Gawande, surgeon and noted commentator on health care issues, writing in the Dec. 14 edition of the New Yorker, suggests that the pilot tests of potential cost-containment initiatives may have real promise.

He notes that it was just such approaches in the early part of the 20th century that led to significant breakthroughs in farming productivity – then the No. 1 problem facing the U.S. economy. This is a slender reed, perhaps, but it offers some comfort in a process that threatens to sink under the weight of a cacophony of conflicting interests.

Opportunities to pass such groundbreaking legislation happen only once in a generation. The last such opportunity in health care came in the mid-1960s when President Johnson pushed through a Medicare bill.

At the time, Republican critics decried the onslaught of "socialized medicine" and predicted the decline of democracy as we know it.

It is ironic that Republicans have become, in this debate, the great defenders of Medicare, indicating that they will not allow Democrats to tamper with any of its current benefits.

The truth is that every developed country that has moved to a system of universal health care – and all developed countries except the United States have done so – have found the program to be widely popular.

That is not to say that other countries don't struggle with aspects of their systems.  However, universal coverage is a sacrosanct and untouchable aspect for all of them.

This is our time to step up to a health care policy that rights our unfortunate legacy of inequality. In such a situation there are always more than enough reasons to vote no.

What we need at this time is a few courageous senators to vote yes. Given Maine's history of senators consistently willing to put the interests of Maine people ahead of party, I hope the final plan that emerges from the Senate will have the support of both Olympia Snowe and Susan Collins.

We can then again proudly say "As Maine goes, so goes the nation."