Everyone deserves access to health care, regardless of wealth or employment.
Amid dire predictions that passage of Gov. Baldacci’s health care reform package will cause the sky to fall, several major points are missing.

Under current conditions, the sky is already falling in our health care system. With 180,000 Maine people lacking the admission ticket to our health care system that insurance provides, both the health system and the uninsured are in crisis.

As a physician who practiced several years in my hometown of Farmington, I remember the challenge of trying to negotiate through the health system to obtain needed X-rays, lab tests, medicines and hospital care for patients who were uninsured. With the numbers of uninsured growing, I would gladly swap these struggles for the possible challenges posed to the health care system by Gov. Baldacci’s plan.

Our health care system, especially in rural areas, now struggles with uncompensated care that results from treating the uninsured. Under Gov. Baldacci’s plan, much of this care will be compensated for, and at market rates, thus reducing uncompensated care by an estimated $80 million in the first year.

We also face a public health crisis.

With an estimated 180,000 Maine people facing the terror of being uninsured, they and their families must struggle with the resulting medical, economic, and emotional devastation that accompanies this lack of health insurance.

Some are even dying. Using national estimates from a 2002 Institute of Medicine study, approximately 72 Maine people die every year as a direct result from lacking health insurance. This is more than the number of Maine people who die every year from fires, homicide, AIDS and from job-related injuries combined.

Maine faces a number of public health challenges – tobacco, obesity, resulting chronic diseases and public health emergency preparedness. However, we cannot adequately address myriad health problems we face unless more of us are able to obtain the admission ticket that health insurance gives to the health care system.

Most developed countries treat access to basic health care as a public health necessity, not something mainly available to those with financial means or who are fortunate enough to work for an employer who offers health insurance. If our society believes that all should be given the opportunity for a basic education through admission to elementary and secondary schools, why is it we deny the basic admission ticket to our health system to one in six of us?

Gov. Baldacci’s plan is a bold step to address this lack of access to our health care system, and his proposal addresses the crises that our health care system and uninsured face. With its coordinated and comprehensive approach, Gov. Baldacci’s plan recognizes a basic tenet: we cannot substantially improve access to health care without addressing cost and quality in a comprehensive and coordinated way. Yet it is these two critical issues of cost and quality that are gathering the most opposition.

A look at our status in the world points out why we cannot afford to increase access without implementing cost containment and assurance of quality strategies. For instance, according to the World Health Organization, the U.S. ranks poorly for access to care (55th for equity of access through financial contribution to health care) and ranks by far the highest in health care costs, spending over $3,800 per person per year compared to $1,700, the average of the 10 countries with the longest life expectancy.

The ultimate test of quality of any health system is to what degree their population is able to live longer and healthier lives. Even with the highest spending in health care in the world, the U.S. ranks only 24th in disability-adjusted life expectancy and 32nd for equality of child survival.

So, with our enormous spending on health care with relatively poor access and quality indicators, we certainly cannot afford to substantially improve access to health care without fully addressing cost and quality. No other country has determined an effective way to do so otherwise.

Gov. Baldacci’s proposal to protect the public health investments in the Fund for a Healthy Maine is also part of this comprehensive initiative and will help assure that all Maine people will have a better opportunity to live longer and healthier lives.

The governor’s plan offers a bold, comprehensive and coordinated approach to address this crisis. Our health care system and more importantly, the people of Maine, cannot afford to not have this plan pass. We all deserve the admission ticket to our health care system and the opportunity to live longer and healthier lives. Some 180,000 Maine people are waiting.

Dr. Dora Anne Mills is director of the Bureau of Health and is Maine’s chief health officer.