On the home front

The Times has an interesting article today, set right here in Maine. It's about the intense pressure the two Senators from Maine (both women, both Republican, and both considered moderates) are facing about health care reform from both sides of the issue. There were a lot of fascinating tidbits.

First off, the reasons why Maine is an interesting case in the broad expanse of American health care:

Though Maine has only 1.3 million residents, the challenges of insuring the entire population are complex. The state has large rural, poor and elderly populations with significant health needs. It has many small businesses and seasonal workers, and few employers large enough to voluntarily offer employees insurance. Meanwhile, most insurers no longer find it profitable to sell individual coverage here, leaving a few companies to dominate the market.

The industrial base for Maine, which was its shoe factories and paper mills, is slowly dying. (One of the few exceptions is Bath Iron Works, which still does a brisk trade in mammoth sea vessels.) Maine's employers simply cannot, as a rule, afford to pay for insurance for their employees. And the dominant insurance company, Anthem (which long ago bought the failing non-profit insurance carrier in the state), continues to raise its premiums and rake in gigantic profits.

The remarkable failure of the free market to meet the health care needs of the state hasn't seemed to dull its shine for Maine conservatives, however:

To Mike Marcotte, an accountant from Lewiston who is insured through his employer, the right thing would be for Ms. Snowe and Ms. Collins to vote against any proposal that includes a public option.

“They need to vote for free enterprise,” Mr. Marcotte said. “Less government is better.”

Mr. Marcotte attended the lunch held in Auburn by the Maine Heritage Policy Center, a conservative group whose leader, Tarren R. Bragdon, told a few dozen attendees that the Democrats were seeking a “significant government takeover of physicians, nurses, hospitals, health insurance and the entire health care system.”

The free enterprise system works for Mr. Marcotte, and that's all that Mr. Marcotte needs to know. That it is failing a sustantial number of Mainers doesn't seem to matter much.

Backing up a bit in the article, there is this interesting passage:

Stavros Mendros, a consultant from Lewiston, is equally wary of insurance companies but his solution is to avoid them completely and risk going without coverage. Mr. Mendros said that when his 4-year-old daughter got sick recently, he took her to the hospital and paid the $1,200 bill, which he said was cheaper than a single month of an insurance premium for his family would be.

“Not having insurance saves me boatloads of money,” he said. “My biggest concern with the government taking over health care is the waiting lists. My daughter didn’t have to wait. I’d rather have a bill than a dead daughter.”

I cannot even begin to understand thinking this blinkered. First of all, clearly Mr. Mendros took his daughter to the ED instead of a primary care office, and thus paid hundreds of dollars more than he otherwise would have. Secondly, public option or no, the ED will be no less accessible under a reformed system. While he can (apparently) afford the $1,200 his daughter's care cost, a large number of Mainers simply could not. Finally, Mr. Medros can thank his lucky stars that his daughter wasn't diagnosed with something like leukemia, with a price tag for treatment greatly in excess of $1,200.

A certain degree of conservative skepticism about public health reform is warranted, as the state's own efforts to cover everyone fell far short. (This was, in part, because of its ongoing troubles with funding.) But the federal government is in a much better position to lower costs than any state-run program could be. Having a public option is the only check on a rapacious private insurance industry, and is a vital part of any meaningful attempt at reform.