Both sides refuse to talk about health care reform in a way that people can understand.

Is it just me or is the public debate over Dirigo Choice starting to get a little stale?

The Democratic mantra is that the program is a good start toward health care reform. The Republican tune is that the policy is a failure so far. Both parties regularly use statistics in order to bolster their viewpoint. They are supported by interest groups that throw around specialized medical jargon without apparent concern for either context or comprehension.

This reminds me of teenagers at a high school dance. The dance partners boogie and bop around a lot but never actually touch. Any time they get close to physical contact, both pull away. They are afraid of what might happen if they danced more intimately. Coming in contact with each other would mean openly debating the political vision that gives each side its logic: How much government should get involved in health care. Until this ideological issue is acknowledged, all the policy arguments just add up to an elaborate dance. Call it the Dirigo Dance.

Two recent op-eds in the Sun Journal illustrate how the dance works. On Feb. 12, Katherine Pelletreau wrote about Dirigo Choice. She is the executive director of the Maine Association of Health Plans. She believes that major reforms are needed. In particular, she states “…the program needs a credible, reliable funding mechanism that is more broad-based and fair.”

Some of her ideas regarding the funding mechanism are puzzling. For example, what exactly does she mean by a reliable funding mechanism? Since the only thing you can count on is death and taxes, sounds like she means a government funding mechanism. If that is what she means, why not just state it clearly?

Pelletreau refers to the controversial $43.7 million savings offset payment (health system savings or new business tax, choose your interpretation), claiming that “… the state’s actions have triggered legal battles and led to questionable new legislation that is creating even more acrimony and ill will.”

Are these legal battles just the beginning of a long fight? Is this part of the negotiating process or a way to legally win your argument and defeat your adversary?

I get the impression that her group feels it is inappropriate for Gov. Baldacci and the Legislature to micromanage the health insurance companies. If that is what she really means, why not just state it plainly?

On Jan. 8, Pat Colwell also wrote about Dirigo Health. Colwell is the state chair of the Democratic Party. He stated that “Dirigo is a compromise reached between people on both sides of the aisle.” He went on to declare that, “We created Dirigo together. Dirigo is a compromise between Republicans, Democrats, the insurance industry and health care providers.” He concluded with “Let Dirigo work, it’s working for all of us.”

All nice inclusive rhetoric, designed to offend no one. Unfortunately, his essay never adequately answers the following crucial question: Is the Dirigo that was created three years ago the same program now?

Many people believe that Dirigo was only agreed to three years ago because all sides knew that the ultimate day of fiscal reckoning was far off in the future. Colwell was present at the creation of the program. Is that actually how it was? If so, why doesn’t he say so publicly? The day of fiscal reckoning is not simply some technical hurdle to get by. It is the core ideological component of the policy and it is getting closer every day.

Why are both sides reluctant to delve right into an ideological conflict? I suspect that Democrats are fearful of how the Republicans might frame the issue. In particular, they might be terrified of phrases like “socialized medicine,” or worse still, “Hillary Care.” The GOP and their allies used these phrases in helping defeat President Clinton’s 1994 reform plan.

Republicans are less afraid of using ideology. They have romanticism and tradition on their side. They can conjure up the image of the small town family doctor and cite employer-based health insurance as how Americans traditionally receive their coverage.

However if the Republicans defend the status quo too vigorously, they will have to explain why there is so much public dissatisfaction with our current system. They might be stuck attempting to rationalize the glaring inequities and shameful gaps in how health care is delivered to Mainers.

Last week, the Legislature held a hearing on the subject. There were accusations of legislative betrayal and unfair treatment to insurance companies. There were counter charges of insurance companies setting rates in a “black box” fashion; with the effect being the public being unable to account for true savings and costs.

The distinctive part of politics in Maine is our voter independence. Thus an ideological “solution” to the health care crisis, championed by either major party, is probably not going to be successful. Thus the Dirigo Dance goes on.

Karl Trautman has taught political science for more than 20 years. He has been a policy analyst for the Michigan Legislature and a research assistant for “Meet The Press.” He chairs the social sciences department at Central Maine Community College and can be reached at [email protected]


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