If you’re one of the 11,000 or so Mainers unlucky enough to have to buy individual health insurance from Anthem Blue Cross, life just got tougher. Insurance Superintendent Mila Kofman approved an average 14 percent increase in individual policies – the only kind Maine regulates.

That actually qualifies as relatively good news. Anthem had requested a 23 percent increase, on top of the 9 percent increase approved last year – for which the company had sued the state, unsuccessfully.

If you get the sinking feeling that health insurance costs are out of control, you’re right. Over the past 10 years, costs have never been under control, and things seem to be getting worse, not better.

Reading through the insurance superintendent’s decision, one alternates between frustration and mystification. Is it really possible that health insurance is so complicated, and so technical, that no ordinary mortal can understand what’s going on?

We learn, for instance, that Anthem seriously miscalculated something called the “allowed-charge triangles” which in turn inflated its estimates. As Kofman dryly notes, “The failure to provide accurate data impairs the ability to conduct meaningful review, and Anthem must take steps to prevent such problems in the future.”

Yet it’s neither mistakes nor extraordinary events that are driving the incredible escalation of insurance costs – as approved, some 14 times higher than our nearly nonexistent inflation rate. It is, instead, business as usual.

With the economy still flat, and household incomes even flatter, health insurance costs stand out even more, but the problem has been with us for some time.

Now, we should acknowledge that not all insurance rates are going up this fast. Individual policies, and the way they are rated, offer peculiar problems. It is not the insurance superintendent’s fault that she is approving rates that so many people will be unable to pay.

Kofman denied Anthem any profit margin last year – it traditionally gets 3 percent — and this year allowed only 0.5 percent. As she points out, Anthem is an enormously profitable company, and Mainers’ ability to pay for its product is rapidly shrinking.

The irony is that we’ve been here before. When the Baldacci administration introduced Dirigo Health in 2003, individual policy rates, and those for small business, were spiraling up. Dirigo aimed to bridge those discrepancies and, despite popular impressions to the contrary, it helped. Maine went from having the highest uninsured rate in New England to the lowest.

Unfortunately, Anthem was then the supplier of Dirigo policies, and they cost just as much, or more, than its other lines. It soon became clear that Anthem was a reluctant participant in this health insurance experiment.

Not only did it resist any price concessions, but, through its trade association, it sued the state over Dirigo financing every year. None of the suits were successful, but that wasn’t the point. By rendering the program “controversial,” it sapped its political capital, and denunciations of Dirigo’s “failure” quickly followed.

Unaccountably, the Baldacci administration had reappointed the previous insurance superintendent, Al Iuppa. At the outset of Dirigo, the superintendent could have mediated, encouraging all parties to compromise. Iuppa did essentially, nothing, and regularly rubber-stamped Anthem’s rate requests.

At one point, sensitive to criticism, Iuppa announced that he was rejecting a 14 percent increase in Anthem’s individual rates, only to quietly approve a 13 percent increase a month later. If Maine had a superintendent of Kofman’s abilities earlier, it might have been different, but that is water long over the dam.

It does foretell ominous developments for national reform, however. There are many things wrong with the way we price medical care. There are few, if any, incentives to conserve resources, salaries are far higher throughout the industry than in any other country, and we have a crazy quilt of cross-billing entities.

My favorite study among those taking on the high cost of health care concludes that health care costs so much because we simply charge more for everything.

I am not among those who think that a future Congress will repeal health reform. It will simply be too difficult to explain why one-sixth of the country should be permanently without regular access to health care. Yet insurance exchanges are not necessarily going to solve the problem Dirigo addressed earlier.

There are plenty of pilot projects in the federal legislation, but nothing that tells insurers that neither individual subscribers, nor employers, nor the economy, can continue to sustain increases of 5, 10 or 15 percent a year. Until there’s a real commitment to change among all parties, but particularly insurers, the crisis will continue to build.