By Gordon L. Weil

Maine Center for

Public Interest Reporting

Trying to strike a balance between cutting government programs and finding money to pay for essential services can be dangerous.

Dangerous for the office holders, who have to decide what to cut and the taxes to pay for the rest. Dangerous for the people who are truly dependent on government help for basic health care.

Nothing illustrates the problem better than the health and human services cuts that Gov. Paul LePage has proposed. Most fall on MaineCare, the state’s version of Medicaid, the low-income health care program.

MaineCare is an entitlement program. Its costs are driven by the number of eligible people using it — now 361,000 — and not by the amount of money appropriated for it. If an entitlement program begins to absorb more money than tax revenues can support, it becomes a target for reduction.

The two obvious ways to accomplish cuts are to define who is eligible more narrowly and reduce the scope of services.

The standard that LePage appears to have applied is that to be covered, the need must be urgent and severe. That standard — all entitlement programs have some standard — is a form of rationing, because it limits the scope of the program. He also proposes reducing the categories of people eligible for MaineCare.

The proposed Maine standard focuses on cutting costs immediately to bring the budget into balance. Few propose raising the state’s relatively high taxes to keep MaineCare intact.

But the proposal would push much of the reduced cost onto hospital users. Either directly or through their insurance premiums, they will pick up the cost of emergency room visits by those who have lost state support. And today’s uncovered health care can become tomorrow’s urgent and severe illnesses, raising future costs.

Health conditions that are not eligible for coverage and left untreated can ripple through the economy, causing costs to employers in lost time and employees in lost income.

A recent story in the New York Times shows the difficulty in cutting costs. President Barack Obama gave Dr. Donald M. Berwick, a political outsider, a temporary appointment as head of Medicare and Medicaid.

Somewhat surprisingly, because the effect of his proposal would be similar to the GOP position, Republicans refused to confirm him, citing his advocacy of a cap on health spending. It was condemned as rationing.

In his parting statement, he said that federal health spending could be cut by 20 to 30 percent by eliminating “activities that don’t have any value.” That would amount to $150-$250 billion a year. Such a cut would have equaled 38 percent of the $4 trillion reduction over the next 10 years that is needed to bring the federal budget under control.

The doctor learned that many competing interests, both inside and outside government, strongly influence decisions about government programs. Expert opinions like his must give way to the net result of the conflicting pressures. His opponents branded him as a person who would “ration” health care, without acknowledging that any proposal, including LePage’s and their own, must draw the line somewhere.

Gordon L. Weil is a contributing writer at the Maine Center for Public Interest Reporting (pinetreewatchdog.org). He is an author and publisher and served as a Maine state agency head. Weil was also a correspondent for the Washington Post and a columnist for the Financial Times. He is a former Harpswell selectman. He may be contacted at [email protected].