[TheMercenary]

Another cautionary tale. As in Mass, now as in Maine.

BAR HARBOR, Me. — When his car repair shop’s health insurance premiums doubled between 2000 and 2002, David White saw the problem as akin to a sputtering engine. So he got under the hood of the state’s health system and tried to fix it.

Seven years later, Mr. White is on seven health advocacy and improvement boards, has helped devise the state’s public insurance plan and has a library of health care books and research papers. He spent so much time on the issue that his business suffered. But he still has no health insurance for himself or his lone remaining mechanic, an experience that is emblematic of his state’s.

Maine is the Charlie Brown of health care. The state’s legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon — solving one problem while worsening another.

But like the Peanuts character, the state keeps trying. Indeed, Senator Olympia J. Snowe, Maine’s senior United States senator and so far one of only two Republicans in Congress to vote for an overhaul, spent two years in the late 1970s as chairwoman of the State Legislature’s joint Health and Human Services Committee pushing small reform efforts. “That’s where I garnered an enormous deference to the issue of health care and its complexities,” Ms. Snowe said in an interview.

Maine’s history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage. Many on Capitol Hill have criticized national reform legislation for similarly doing little to tame costs.

To Ms. Snowe, Maine’s past shows that change, while needed, should be incremental because mistakes are common. This is among the reasons she opposes an immediate public insurance option. “I mentioned to the president that people can’t digest everything at once,” she said in an interview.

To conservatives, Maine proves that government efforts to strictly regulate the nation’s health insurance market are doomed. Many of the reform proposals circulating on Capitol Hill have already been tried in Maine.

But a state-sponsored insurance plan has been capped at fewer than 9,000 because of financing problems, and the most common choice of those buying new plans in the state requires them to spend at least $15,000 a year before the insurer pays anything — leading many to avoid important medical visits.

Russ Sargent, 50, the owner of Yes Books in downtown Portland, has a shock of frizzy hair and a $10,000 annual deductible. He pays doctors in cash and recently scheduled a colonoscopy for which he agreed to pay $900 up-front. He is not confident that his insurer would pay if he ever got truly sick.

“I have friends in the same situation as me, and we all go through life with our fingers crossed hoping we never get sick,” Mr. Sargent said. “If I got cancer or needed a kidney, I’d go bankrupt. We all would.”

To help people like Mr. Sargent, the state is one of 17 that limit how much insurers can charge people for being older, and it does not allow exclusions for previous illnesses — both policies that are part of national reform proposals.

But one result is that premiums for younger people are relatively high. Although national proposals would require that nearly everyone get coverage or pay a penalty, Maine’s Legislature rejected such a mandate so many young people do not or cannot buy insurance — further skewing the insured pool to sicker and older people and making premiums that much higher.

http://www.nytimes.com/2009/11/11/he...maine.html?hpw