Peter Mills's latest article on Dirigo

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J. McKane
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Peter Mills's latest article on Dirigo

Peter Mills: Deliver health care, not insurance
By Andy Kekacs
Copy Editor: The Village Soup

AUGUSTA (Dec 23): The DirigoChoice state-subsidized health insurance plan has become a "nightmare of cost" that threatens to drive people currently on private insurance out of the system, according to Sen. Peter Mills, R-Cornville.

Mills, one of several people vying for the Republican gubernatorial nomination, said Dirigo "has the soundness of a chain letter."

If not overturned by the courts, a $43.7 million "savings offset payment" that the state wants to levy on private insurers to fund Dirigo will likely be passed on to Maine workers and businesses through higher insurance premiums.

"To cover just 2,300 previously uninsured people [through DirigoChoice] is costing us a 2-3 percent tax on the other 700,000 people who are paying into the system," said Mills. "[That] tax is enough to drive out some people who would otherwise continue buying their own insurance. I am concerned that we will lose as many people from the market as we presently protect through Dirigo."

Mills, who has served five terms in the Maine Senate and one in the House, is known for his outspoken and independent views on state finances. While he is a fiscal conservative, Mills has reached across party lines to explore pragmatic solutions to the state's continuing budget woes.

The senator is no longer a supporter of DirigoChoice. He said the health insurance program has changed substantially since it was first proposed to the legislature, in particular the mechanism for funding the program.

"The original model, upon which two-thirds of the legislature voted, was primarily funded by employer premiums and matching federal funds," said Mills. "It was almost going to be a money machine."

That model proved to be unrealistic, however, and Mills said a new initiative is needed.

"One trouble with Dirigo is that so much of the money is kept by Anthem [Blue Cross, which administers the plan under a contract with the state] as profit and cost of administration. Presently enrolled clients are not necessarily receiving much health care. They are receiving 'insurance,' the purpose of which is to protect their assets and not necessarily their health."

Mills favors a different approach.

"I am tempted to bypass the insurance industry [altogether] to offer direct preventative and clinical services to the poor, with sliding-scale cost participation by patients," he said.

The senator proposes to extend the reach of public health services through, for example, more school-based health clinics, low-cost or free dental clinics, expanded rural health centers and other medical facilities with sliding-scale fees, and greater use of regional hospitals to improve the health of the state's largely rural population.

"Many of these services could be covered by Medicaid," he said.

Mills is offering a "12-step plan" to wean Maine from a perceived addiction to unsustainable tax and budget practices. The plan can be seen at millsforgovernor.com/12steps.htm. Among his other thoughts for addressing Maine's health-care needs:

"¢Create a high-risk insurance pool with disease management features to replace Dirigo and revive the competitive insurance market.

"¢ Impose taxes or fees to discourage unhealthy behavior that costs the state money to repair.

"¢ Create a statewide, secure, electronic medical information system for patients and providers.

HenryGonzalez
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Re: Peter Mills's latest article on Dirigo

[quote="J. McKane"]The senator is no longer a supporter of DirigoChoice. He said the health insurance program has changed substantially since it was first proposed to the legislature, in particular the mechanism for funding the program.
"The original model, upon which two-thirds of the legislature voted, was primarily funded by employer premiums and matching federal funds," said Mills. "It was almost going to be a money machine."
That model proved to be unrealistic, however, and Mills said a new initiative is needed. [/quote]

:roll:

Anonymous
A few comments on the Health Care reform proposals of MILLS.

[b]Bolster health care[/b]

[quote]Create a high-risk pool with disease management features to replace Dirigo Health and revive the competitive insurance market[/quote].

--Way too simplistic a statement.

DIRIGO primarily addresses that group of people between 'middle income' and 'poverty', i.e. 200% of poverty; a high risk pool sorts out the sickest and most expensive to treat and subsidizes the cost of their health insurance premiums.

Replacing DIRIGO is actually rather easy, since it has failed to cover the 'uninsured' and those it did cover are small businesses and their employees who had private health insurance. Both groups have the ability to pay; so making a major effort to revitalize the health insurance market or baring that, to allow Mainers to compete nationally for their health insurance would lower our individual and small group(a nice fiction btw.) policy to where those people who now have DIRIGO CHOICE policies would be able to pay for them and have a wider set of options. Businesses could, gasp, raise their prices to pay for them...like that guy selling pizza and ice cream in Bethel. I'd bet if you closely examined the assets of all those small business owners, you'd find plenty of 'wealth' being accumulated.

Depending on what he means by 'disease management features', it could also direct care and treatment resources on specific segments of the high risk pool. I have long advocated going to direct care with, for example, free clinics at every hospital....very inexpensive!, and cutting out the insurance company layer. High Risk care can also be focused on sub populations, i.e. HIV infected.....maybe you won't drive down the cost of care for everyone who is HIV positive; but as new technologies come on the market, we'd have an easy way to disseminate and test them.

[quote]Create a statewide, secure, electronic medical-information system for patients and providers.[/quote]
..Great, let's start with those intakes and health risk examinations that DIRIGO CHOICE enrollees avoided filling out or taking.

There are many such information systems....depends on which information, i.e. lab results and what formats, i.e. scans; and whose privacy or proprietary interest---E. Maine Med tried this over a decade ago and got stopped in their tracks when specialists who interpret x-rays, diagnostic tests, and make treatment plans, etc. claimed their work was proprietary and couldn't be used with out their permission. The Hospital was simply dumping writeups in one big file, largelyopen to all. It was on-line and then got halted with either a court action or threat of one. I lost track since the issues were so fundamental.

As everyone knows, if people can hack into your financial data; they can hack into your mental health counseling records. As someone who had access to many mental health and medical records; there is a lot of negative information in them. Do you want your sexual feelings towards your mother available? The US PUBLIC HEALTH CORPS had the full record of the mandatory psychoanalysis for its officers in the records. Interesting reading to try and correlate success inthe Corps and their sexual feelings as interpreted by a Freudian.

[quote]Extend the reach of public health with, for example:
More school-based health clinics;
Low-cost or free dental clinics;
Expanded Rural Health Centers and other medical facilities with sliding-scale fees;[/quote]

Sounds like Peter Mills had dinner with his sister.

This makes for a typical politican's 'sound bite'....goes nicely with the 'plight of Maine's rural poor'; but many areas seem to be overrun with various health care clinics all competing for different subpopulations. Doubt me? How many different groups offered flu shots this year? Right, everyone is in on the flu epidemic prevention business.

Before Mills lards up the public health industry, he would be wise to read up on the long range costs of retirees and others to this system:
[i][quote]December 26, 2005
[b]Huge Rise Looms for Health Care in City's Budget [/b]
By MARY WILLIAMS WALSH
and MILT FREUDENHEIM
When the Metropolitan Transportation Authority proposed making new workers chip in more to its pension fund than current workers do, it was enough to send the union out on strike and bring the nation's largest mass-transit system to a halt for three days.

But the cost of pensions may look paltry next to that of another benefit soon to hit New York and most other states and cities: the health care promised to retired teachers, judges, firefighters, bus drivers and other former employees, which must be figured under a new accounting formula.

The city currently provides free health insurance to its retirees, their spouses and dependent children. The state is almost as generous, promising to pay, depending on the date of hire, 90 to 100 percent of the cost for individual retirees, and 82 to 86 percent for retiree families.

Those bills - $911 million this year for city retirees and $859 million for state retirees out of a total city and state budget of $156.6 billion - may seem affordable now. But the New York governments, like most other public agencies across the country, have been calculating the costs in a way that sharply understates their price tag over time.

Although governments will not have to come up with the cash immediately, failure to find a way to finance the yearly total will eventually hurt their ability to borrow money affordably.

When the numbers are added up under new accounting rules scheduled to go into effect at the end of 2006, New York City's annual expense for retiree health care is expected to at least quintuple, experts say, approaching and maybe surpassing $5 billion, for exactly the same benefits the retirees get today. The number will grow because the city must start including the value of all the benefits earned in a given year, even those that will not be paid until future years.[/quote][/i]

My clients all did 'circuit riding' to small rural hospitals or clinics one or two days a week or a month; the more the specialized the practice the greater the likelyhood they spent time in outlying areas.

One problem that is somewhat unique to Maine, is health clinic staffing during tourist and vacation season. Whether ski resorts, or islands, or sailing or yahoos white water rafting or mountain biking in the most inaccessible areas of Maine; this is a very 'at risk' population whose accidents are extremely expensive. Having watched several hang gliders miss a lift and go down in rocks, and then wait over an hour for some kind of EMS; this is a very difficult area to serve.

Linking Cell phone technology and telemedicine and even helicopters or other off road rescue vehicles into a seasonal response team would make Maine a much safer place to visit. Relying on rural health clinics for these extreme emergencies is probably not good medicine or public health.

[quote]More use of regional hospitals to improve the health of our majority-rural population;[/quote]

This begs the question of the financial health of these rural hospitals under Dirigo....and it isn't good! Most are distressed, under financed and run in the red. They are poorly equipped as well.

Peter would do well to focus on some kind of financial scheme to have first class, fully staffed, rural hospitals.

A better role for a rural hospital could well be in long term recovery or treatment of chronic disease....remember TB sanitariums, or polio wards or when TOGUS filled most of those beds? Combine the high risk pool with health care specialization apportioned out to rural hospitals. It's worth a look!

[quote]Taxes or fees to discourage unhealthy behavior that costs us money to repair.[/quote]

Like kicking out of DIRIGO CHOICE that pizza/ice cream place in Bethel featured in the PPH on Sunday? With obesity and nutritionally linked disease a major health problem in Maine, the last thing DIRIGO should be doing is bailing out pizza places unless they sell only nutritious pizzas and no ice cream.

Kinda makes you wonder which other causes of the health care mess in Maine are being subsidized by Dirigo? Drug dealers? Baby factories? Where is all that "transparency" we keep hearing out of Baldacci's office when it comes to the details of who is getting DIRIGO CHOICE policies?

Otherwise a good start for Mills. Hope a few of the other candidates address specific reforms.

cover_maine
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Peter Mills's latest article on Dirigo

There is one real problem in cracking the hard nut of the uninsured.....those who simply will take their chances no matter what.

On one end of the spectrum are the folks who are eligible for free health plans but don't enroll. I suspect free primary care wouldn't move these people either.

In the middle are people of some means who are eligible for an employer plan, subsidized by the employer, but opt for buying toys rather than enrolling in the plan. While the rates for some are too high and I sympathize with some, others decline coverage when it's less than a dollar a day.

At the other end of the spectrum is the 7% of those with incomes in excess of $75,000 who go without health insurance. What's their excuse?

This area is Chris O'Neil's cause -- and he is right. Without some type of mechanism that requires each individual to have some form of coverage, private insurance or government program, we won't get very far in achieving universal coverage (NOT Universal or Single Payer Health Care) and spreading the risk and cost of health care evenly.

Anonymous
Peter Mills's latest article on Dirigo

I'd rather seperate 'universal coverage', i.e. health insurance; from universal access to health care, and subsidized as needed.

Two different concepts.

Even if you forced everyone into DirigoChoice; you still have the underlying policies of Medicaid and Medicare and Champus and.....to deal with.

Scuzzbags won't co-pay and will lie and steal from public health clinics....and there are a lot of these people in Maine. I'd love to research out the health care histories of those 10,000 drivers with multiple suspensions. I bet DirigoChoice stayed away from the uninsured because of all the problems they bring into health care. I took a Hilton Health care workshop on collecting debt with a packed room of collection & billing specialists. I was astounded at the extent of 'bad debt' run up by people who won't pay, no matter how little. When the cost of collection exceeds the amount of the debt it is written off. Won't change under Dirigo or a private policy.

The ECONOMIST had a big article on the Blair administrations renewal of the 32 public hospital trusts in Great Britain using private investment trusts, i..e public hospitals borrowed private money for capital expansion and renovation. Turned out to be an expensive proposal, and illustrates the immense long range problem caused by socialized health care. Canada's billion dollar investment in their system is another example.

Worse are the parrots who run around Augusta babbling about how wonderful the British and Canadian health care systems are; without a clue to the enormity of the cost of fixing them up to global standards.

gopcollegestudent
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Peter Mills's latest article on Dirigo

Impose taxes or fees to discourage unhealthy behavior that costs the state money to repair.

Do we need anymore taxes or fees????? roll

cover_maine
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Peter Mills's latest article on Dirigo

That's right....we already have the slots in Bangor....a tax on stupid people.

Anonymous
Peter Mills's latest article on Dirigo

Kinda like how do you make students pay back their loans when writing letters doesn't work?

I think I've pretty well implied that UNENROLLING those people whose lifestyle isn't changing while enrolled, i.e. if they don't take the initial health risk assessment, howyah gonna know?????; they you can change their levelof co-pay's or eligiblity for certain benefits. This a major public health problem, esp. for the fat nannies who run the nanny state. Park in the PROP. parking lot and watch them eat fast food and smoke.

Changing the lifestyles of the many obese people in Maine is difficult; but the last thing we should be doing is subsidizing the DEALER of the drugs these people eat!

Dan Billings
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Peter Mills's latest article on Dirigo

[quote="cover_maine"]At the other end of the spectrum is the 7% of those with incomes in excess of $75,000 who go without health insurance. What's their excuse?[/quote]

Maybe they have made the rational choice that they can afford to self-insure? I would think that a person in such a position would at least buy a high deductible plan.

[quote="cover_maine"]
This area is Chris O'Neil's cause -- and he is right. Without some type of mechanism that requires each individual to have some form of coverage, private insurance or government program, we won't get very far in achieving universal coverage (NOT Universal or Single Payer Health Care) and spreading the risk and cost of health care evenly.[/quote]

Aren't many of the uninsured people in their 20's who don't use the health care system much? Wouldn't mandated coverage end up being a further income redistribution from the young to the old?

Anonymous
Peter Mills's latest article on Dirigo

yup, kind of a quasi-tax on the young and healthy....DIRIGIRLS insist on universal enrollment...Socialized health care on the installment plan!

There are a lot of parallels between a universal insurance scheme and the taxation system. In effect, single payor that is outside the taxing system becomes yet another taxation system. The 'rich' are the young, healthy, single people; while the 'poor' are the high risk poor and others with high health costs.

When you start moving public health and other health costs into a single payer system that should free up money from the general revenue fund for future spending.....I tell yah, it's a heck of a system! Gotta hand it to the Augustacrats; they really know how to run a profitable government!

J. McKane
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Peter Mills's latest article on Dirigo

[quote="cover_maine"]

This area is Chris O'Neil's cause -- and he is right. Without some type of mechanism that requires each individual to have some form of coverage...[/quote]

Required coverage is just little scary to me. I've heard it compared to required auto insurance and I believe that is comparing apples to oranges - one doesn't necessarily HAVE to own a car.

If people (higher income people expecially) want to take the chance and not buy insurance - fine - but their debt for health services should not be treated any differently than any other debt.

Slingblade
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Peter Mills's latest article on Dirigo

FLIP - FLOP!

J. McKane
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Peter Mills's latest article on Dirigo

[quote="Slingblade"]FLIP - FLOP![/quote]

?

Anonymous
Peter Mills's latest article on Dirigo

If you mean 'flip flop' in regard to Chris O'Neil's positions; I'd say 'yes' .

He is a very smart legislator who was one of the leaders to get Dirigo passed; after it had he started having misgivings and then started openly discussed them.

A smart Republican candidate for governor would do well to consult with him re. sellable options/reforms to Dirigo.

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