Maine’s landmark health program, Dirigo Health is approaching its fifth birthday. It’s time for a checkup: how is it doing? As with all things political, it depends on whom you ask.

Supporters are happy because the program recently got a much-needed cash infusion from the state. Where will the money come from? Partially from increased taxes on soda, beer and wine. Supporters hailed the recently passed legislation as evidence that the state is committed to the ideals of Dirigo.

Dirigo is still controversial, however. By some accounts, the program has approximately 14,000 members. Critics argue it is time for the state to admit this experiment has been unsuccessful. As Tarren Bragdon of the Maine Heritage Policy Center wrote recently:

“Let’s face it. Gov. John Baldacci’s Dirigo Health planis a costly failure After four years and lackluster enrollment, there are still some 122,000 Maine people without health coverage.”

The Dirigo tax increases spurred some to call for a people’s veto of the law. If the effort is successful, Maine voters will have a chance to veto the tax increases in November. So, Dirigo is under attack.

What should be done?

Theoretically, the state could appropriate more money for the program. But it cannot – Augusta doesn’t have the money, and it won’t in the near future. The state just barely balanced its budget a few weeks ago. We are experiencing slow economic growth. Most Mainers still want to see lower state taxes.

Augusta could also reinstate one of Dirigo’s controversial funding mechanisms: the savings offset payment provision.

But it probably won’t. Too contentious and abstract.

Here’s the awful truth: Dirigo will struggle along for years, producing only marginal changes. In terms of its effectiveness, it will be in a constant state of indeterminacy. Supporters will point to small victories and emphasize the individual human stories of its successes. Detractors will remind us enrollment is still extremely low.

Both will use statistics and ideology to justify their position.

Neither side can win the argument, however. There won’t be enough support to kill the program outright, but there won’t be enough backing to take Dirgo to the next level – securing a predictable, stable source of funding.

The essential problem? Health care is simply too expensive and complicated for one state to fix. It is incredibly difficult to grow Dirigo because of health care’s cost and complexity. Insurance keeps getting more expensive. Who is to blame for medical inflation? Doctors? Patients? Hospitals? Insurance companies? Everyone?

Individuals that don’t have adequate health insurance cannot be neatly pigeon-holed into a single explanation. Some young people, thinking nothing bad will ever happen to them, never purchase health insurance. Others cannot afford it. Many small businesses can only make profit by not paying for employees’ health insurance.

Moreover, much of health care policy is beyond Augusta’s control. Maine people are affected when federal health care programs alter their rules, and thus trigger revenue holes for the state. The emblem for this is Medicaid.

Some might want to give up the Dirigo dream, and admit the goal of moving towards universal coverage is unrealistic. It was the ultimate false government promise. Our idealistic ship has crashed on the rocks of fiscal reality.

Instead of abandoning the dream, perhaps it needs to be adjusted. We could admit we cannot do it alone, and that we need help. Where should we look for financial assistance?

The federal government.

Some might balk at asking the feds for direct help. Why? Going to Washington might be interpreted as tacitly admitting the program is not working. This could undermine support for the program itself.

Moreover, Dirigo’s identity would be blurred; it might be seen as more of a federal/state partnership rather than a bold state attempt at health insurance reform.

Fiscal conservatives, in particular, might recoil from asking for Washington for more money. Where will the federal government get the money to help us out?

The Robert Wood Johnson Foundation recently released a study that analyzed family insurance coverage from 2001 to 2005.Its findings are economically brutal: nationally, while family policyholders’ income went up three percent during this time period, the employee cost of family coverage went up 30 percent.

Ouch.

Brian Quinn of the Robert Wood Johnson foundation was quoted recently saying “states such as Maine ‘deserve a lot of credit’ for developing innovative solutions to try and expand coveragebut ‘this is ultimately a national problem that needs a national solution.'”

The Dirigo program is not thriving. But its ideals are not dead. They just need support.

Karl Trautman is chairperson of the social sciences department at Central Maine Community College. He received his doctorate in political science from the University of Hawaii. He can be reached at [email protected].