Better health, better budgets

Now is the time for pragmatism and policy creativity. Maine faces a difficult budgetary environment, made worse by cutting tax revenues, the bulk of which had come from the most well-off.

Proposed and passed cuts undermine health clinics, causing patients to lose access to ongoing care and screening and so increase preventable illnesses and deaths, swell emergency department use, shift costs to people with insurance and cause layoffs.

Down the road, much can be gained from the Affordable Care Act’s emphasis on programs that coordinate care for patients with significant — and expensive — medical problems. While it’s striking that 55 percent of MaineCare’s spending goes to 5 percent of those covered, Maine is by no means alone in having a small percentage of patients account for a majority of spending.

As Atul Gawande points out, with health care costs rising, we can afford education, transportation, medical and other needs if we adopt evidence-based, patient-centered methods to improve health care delivery systems. If the U.S. spent as much per person on health care as countries that cover more and have better outcomes, we’d have a long-term budget surplus.

Looking to Massachusetts, under Romneycare, one study found significant improvements in people’s health. Another study found that emergency room use and patients’ costs are down, with more needs met: “About nine million Americans lost health insurance in the downturn — and almost none of them lived in Massachusetts.”

In our community, Bangor Beacon received one of just 17 federal grants from an Affordable Care Act (Obamacare) competition with hundreds of applications. Developing electronic medical records ensures providers have patients’ information. Doing intensive work with individuals with diabetes and high blood pressure, health is improved and money saved. And Maine is one of just five states to receive a grant from the Center for Integrated Health Solutions to help “behavioral health providers and general medical providers” electronically share medical records.

To be sure, these endeavors do not fill today’s budget hole. Still, pragmatic solutions must set aside rigid ideological commitments and harsh rhetoric and demonstrate respect for citizens and other decision-makers.

Sometimes Maine’s governor acts as if he is still a manager in the private sector speaking to employees rather than the head of one branch of government interacting with a co-equal branch defined by the state Constitution. It was wrong for Gov. LePage to direct DHHS staff to stop providing information to the Appropriations Committee, after the governor criticized legislators for asking the DHHS commissioner “a gazillion questions” and suggesting that committee deliberations were merely “normal politics,” Now with news about problems with the DHHS computer system, it turns out that, despite protestations to the contrary, the numbers provided to legislators were wrong — and his administration knew.

Perhaps the best that can be said is that Gov. LePage is bipartisan in his distaste toward legislators, criticizing Republicans and Democrats alike (although hitting Democrats more sharply). But disrespecting the Legislature does not promote problem-solving.

The U.S. and Maine Constitutions both say government exists to promote the “general welfare,” in other words, to help people and the community. And, of course the costs that democratically elected officials have decided should be incurred are paid for by taxes. The U.S. Constitution puts both of these together in one phrase: “The Congress shall have the Power to lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and general Welfare of the United States.”

Yet, in a radio address Gov. LePage mistakenly quoted Alexis de Tocqueville as saying, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Calling programs that care for people “bribery” is an ideologically-based position that does not show respect for our constitutional order.

While Americans have always argued about what exactly government should do and how it should be financed, it’s not inappropriate — and certainly not bribery — for democratically selected officials to decide to spend money for the people’s needs.

Promoting citizens’ health and enabling them to live with dignity furthers “the general welfare.” With vision, creativity and practical wisdom, we can create greater health and opportunity for all.

Amy Fried is a professor of political science at the University of Maine. You can follow her on Twitter at twitter.com/ASFried and on her blog, pollways.com.