Before cutting MaineCare reimbursements to hospital-based doctors to save $3.5 million, Gov. John Baldacci should see if Washington solves the problem for him.

In economic stimulus legislation unveiled Thursday, congressional Democrats offered $87 billion to states for Medicaid. The funds are temporary, a likely one-time injection, but as the package moves toward enactment, its presence could render the MaineCare cuts moot.

For now, at least.

The longer-term issue for the Baldacci administration, and likely his successor, is paying the state’s ballooning debt for treating MaineCare patients. This important obligation is growing well beyond its ability to pay.

Hospitals were galled by the governor’s cut – rightfully so. Few, if any, industries are unilaterally expected to take less for the same service. Health care providers have been a zero-interest credit card for MaineCare for too long.

This has shifted costs to the privately insured, increasing their premiums and putting good policies beyond many employers and self-employed, leaving high-deductible policies with “catastrophic” terms as the only vestige of coverage available.

And a proposed solution, the quasi-private DirigoHealth, has its own foibles.

The landscape is this: Maine has government-provided insurance that doesn’t pay its bills, subsidized insurance that cannot afford to operate and private insurance that is too expensive.

There are no quick fixes. What Maine needs is to get away from pursuing added coverage as the answer to health care and look toward containing costs within the current systems.

Cost is where all roads meet, and what has tripped initiatives so far. Dirigo’s aim of insuring Maine’s uninsured is hampered by costs of that coverage; unless a politically feasible and fair funding source for the program is found, it will never reach its lofty goals.

MaineCare/Medicaid is the same. Unless costs are contained, the fiscal divide between hospitals and government will grow, until delivery of health care is harmed.

That goes for private insurance, too. If costs of care are addressed, more affordable insurance premiums and policy terms should follow, through both government leverage and consumer demand.

As a state, Maine has done tremendous work in covering its uninsured. But now, it appears the cost of this success is an unsustainable health-care system that probably can’t maintain quality care without a fresh commitment to addressing out-of-control costs.

Maybe Dr. Erik Steele, chief executive of Blue Hill Hospital, said it best in a speech last October. “Given the disastrous implications of unaffordable health care it is clear that the gun is against our heads. We are going to fix this problem or disaster awaits.”

The right step is making costs the top priority, not more insurance coverage. Under current conditions, it looks like Maine cannot afford to cover another person.

The first step, however, is for Gov. Baldacci to let Congress act on the stimulus, before cutting MaineCare reimbursements anew.

Unlike the overall cost of health care, this problem the federal government just might solve.