With health care reform dominating talk, the Maine Center for Economic Policy has released a tidy appraisal of Dirigo Health for the program’s sixth birthday, to evaluate its history and identify lessons for national policymakers.

The left-leaning center’s analysis is broad, concise and fair. It neither acts as apologist nor publicist for Dirigo; rather, it paints it as concurrent victim of lofty expectations, incorrect assumptions, flawed policy, negative publicity and fierce opposition. (All true.)

And, as an object lesson for national health care legislation, it’s a wealthy resource of experience both to emulate and forget.

Here are the highs, in bullet form:

• Near-universal coverage is attainable. With expansion of Medicaid and creation of Dirigo in 2003, Maine’s rate of uninsured propelled to fourth-lowest in the country in 2007, behind Massachusetts, Hawaii and Minnesota, an overall reduction of uninsured by 20 percent.

• Savings are in the system. Dirigo, according to MECEP, has calculated $160 million in savings by capping hospital spending and reducing hospital charity care and cost-shifting. (Dirigo also slowed premium increases by insurers, but only when insurers voluntarily capped profits. That cap was not renewed, and insurance costs have increased accordingly in the past two years.)

• And, smart initiatives to increase quality of care and expand medical information can be sustained. Dirigo’s legacy just might be its sponsorship of the Maine Quality Forum and Maine Health Data Organization, whose research and findings should help drive down medical costs in Maine.

Now, the lows:

• Coverage can’t be expanded, either through new eligibility rules or programs, without knowing how to fund or how much funding is needed. Dirigo is exhibit A. The program has long suffered doubly on its revenue side: money has neither been sufficient for it, nor predictable.

• Too many compromises hurt. Opportunities for cost-containment in Dirigo were, according to MECEP: streamlining Maine’s 39 hospitals (New Hampshire has 9), capping hospital spending and insurance profits. The first was stripped from the bill, the latter two made voluntary.

• And, we can’t operate in a public-private sphere. The partnership between the state and Anthem to peddle Dirigo products never bore fruit. A public option has to be public, in every sense.

There they are: lessons of Dirigo. So, a question: What should the national folks learn? The “blink” answer seems pretty clear: Make costs the priority, because even the most perfectly crafted policy to provide coverage and care can wither, if deprived of cash. 

But the real lesson is deeper than that.

For six years, Dirigo has floundered without a fiscal foundation, unaided by a federal government that encouraged states to be laboratories for reforms. This signals that states, by themselves, cannot tackle health care effectively. The problem is too big for them and their budgets. (Especially now. How many state governments could fund experiments to reduce the uninsured?)

What Dirigo symbolizes is the time to pass the torch to Washington, with this message: we have tried to act, and this is what has happened so far. We cannot continue to struggle, and we cannot continue to be ignored. There’s too much at stake for our citizens, economy and society.

It’s time to act as a nation, and end the experiments.

[email protected]


Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.