Wednesday, January 6, 2010

From a Priest in the Most High Cathedral of Perpetual Dependency

Well, wouldn't you just know it. Here in the state of Maine, the creators and supporters of Dirigo Health Care are busy as ever telling all who will listen that its astonishing failure is actually a mis-characterization of brilliant success. And in Washington we're witnessing the incredibly discouraging nationalization of our health care, complete with the ugliest vote buying, selling out, and legislative abuses in recent history. Even though the majority of the public wants no part of it. And promises that things would be different now.

Seems like a perfect time for a true believer in Government benevolent despotism to come up with an even more destructive Health Care "reform" proposal here in the economic backwater that is Maine. Enter a Priest from the Most High Cathedral of Perpetual Dependency. You know the's that imposing domed structure on State Street in Augusta, just below the Blaine House.

The Priest, to be specific, is Brunswick's own Charlie Priest, a Representative in the State Legislature.

Priest has submitted HP 955/LD 1365, "An Act to Establish a Single-payer Health Care System." Several others have jumped on board as co-sponsors, including our own Senator Stan Gerzofsky, and Rep. John Martin, notably.

I haven't seen any publicity on the proposal at this point, so most of you are probably unaware of the Priest's initiative. This may be by design, but who knows, given the inability of our local media to do much in the way of informing on anything much beyond fender benders.

I'll get to the details in a moment. But before I do, I came across some interesting prior work of mine as I was going through some papers. It was a column I wrote after the celebrated passage of "LD1, An Act to Increase the State Share of Education Costs, Reduce Property Taxes and Reduce Government Spending at All Levels." Local elites were profuse in their praise, calling the bill meaningful, historic, and comprehensive tax relief. How's that tax relief working out for you, bubby?

The name of the Act is, in and of itself, a blatant falsehood willingly perpetrated upon a gullible and uninformed public. Added to that is the best passage from the reporting following passage: Senator Beth Edmonds, the bill cosponsor, told Professor Chris Potholm of Bowdoin College that "people don't care about the particulars, they just want action."

Think about that assertion for a moment; how's that for clarifying how our elected officials approach what they see as a problem? How's that for looking out for our best interests and making sure that unintended consequences are avoided or at least minimized? How's that for weighing long term effects before acting? How's that for ethical stewardship of public resources? How's that for respecting the voters?

Frankly, in today's climate, the statement disgusts me ten times more than it did just a few years back. Is it any wonder no one bothers to read bills before voting on them? It's clear - the standard is to do something, do anything! Consequences be damned; someone else years from now will have to deal with the aftermath; what we need now is something to brag about to "the people."

Phooey on them all, I say. How can you respect people who call themselves "public servants" and keepers of the public trust who make such telling and asinine statements?

Now back to the Priest's proposal. What follows is the bill summary direct from the state's web site, and I've highlighted the passages I find most "notable," if you'll allow me a bit of editorial license.


This bill establishes a universal access health care system that offers a choice of coverage through organized delivery systems or through a managed care system operated by the Maine Health Care Agency and channels all health care dollars through a dedicated trust fund.

1. Part A of the bill does the following.

It establishes the Maine Health Care Plan to provide security through high-quality, affordable health care for the people of the State. The plan becomes effective when 2 other New England states enact substantially similar legislation. All residents and nonresidents who maintain significant contact with the State are eligible for covered health care services through the Maine Health Care Plan. The plan is funded by the Maine Health Care Trust Fund, a dedicated fund receiving payments from payroll taxes and payments from the General Fund or any other sources. The Maine Health Care Plan provides a range of benefits, including hospital services, health care services from participating providers, laboratory and imaging procedures, home health services, rehabilitative services, prescription drugs and devices, mental health services, substance abuse treatment services, dental services, vision appliances, medical supplies and equipment and hospice care. Health care services under the Maine Health Care Plan are provided by participating providers in organized delivery systems and through the open plan, which is available to all providers. The plan is supplemental to other health care programs that may be available to plan members, such as MaineCare, Medicare, the Dirigo Health Program, the federal Civilian Health and Medical Program of the Uniformed Services, the federal Indian Health Care Improvement Act and workers' compensation.

It establishes the Maine Health Care Agency to administer and oversee the Maine Health Care Plan, to act under the direction of the Maine Health Care Council and to administer and oversee the Maine Health Care Trust Fund. The Maine Health Care Council is the decision-making and directing council for the agency and is composed of 3 full-time appointees.

It directs the Maine Health Care Agency to establish programs to ensure quality, affordability, efficiency of care and health planning. The agency health planning program includes the establishment of global budgets for health care expenditures for the State and for institutions and hospitals. The health planning program also encompasses the certificate of need responsibilities of the agency pursuant to the Maine Revised Statutes, Title 22, chapter 103-A and the health planning responsibilities pursuant to Title 2, chapter 5. The agency is also required to contract with a 3rd-party administrator for claims processing and data collection services.

It requires the State Controller to advance $400,000 to the Maine Health Care Trust Fund on the effective date of the Part, July 1, 2010. This amount must be repaid by the Maine Health Care Agency by June 30, 2012.

2. Part B of the bill establishes the Maine Health Care Plan Transition Advisory Committee. Composed of 20 members, appointed and subject to confirmation, the committee is charged with holding public hearings, soliciting public comments and advising the Maine Health Care Council on the transition from the current health care system to the Maine Health Care Plan. Members of the committee serve without compensation but may be reimbursed for their expenses. The committee is directed to report to the Governor and to the Legislature every 6 months beginning July 1, 2010. The committee completes its work when the Maine Health Care Plan becomes effective.

3. Part C of the bill establishes the salaries of the members of the Maine Health Care Council and the executive director of the Maine Health Care Agency.

4. Part D of the bill prohibits the sale on the commercial market of health insurance policies and contracts that duplicate the coverage provided by the Maine Health Care Plan. It allows the sale of health insurance policies and contracts that do not duplicate and are supplemental to the coverage of the Maine Health Care Plan.

5. Part E of the bill directs the Maine Health Care Agency to ensure employment retraining for administrative workers employed by insurers and providers who are displaced by the transition to the Maine Health Care Plan. It directs the Maine Health Care Agency to study the delivery and financing of long-term care services to plan members. Consultation is required with the Maine Health Care Plan Transition Advisory Committee, representatives of consumers and potential consumers of long-term care services and representatives of providers of long-term care services, employers, employees and the public. A report by the agency to the Legislature is due January 1, 2012.

The Maine Health Care Agency is directed to study the provision of health care services under the MaineCare and Medicare programs, waivers, coordination of benefit delivery and compensation, reorganization of State Government necessary to accomplish the objectives of the Maine Health Care Agency and legislation needed to carry out the purposes of the bill. The agency is directed to apply for all waivers required to coordinate the benefits of the Maine Health Care Plan and the MaineCare and Medicare programs. A report by the agency is due to the Legislature by March 1, 2011.

6. Part F of the bill clarifies that, throughout the Maine Revised Statutes, the words "payer" and "payor" may be used interchangeably and have the same meaning.

7. Part G of the bill establishes a 7.5% payroll tax on wages and earnings, including self-employed earnings, and dedicates that tax revenue to the Maine Health Care Trust Fund.

If this doesn't get your tank top all knotty, then you and I don't have too much in common when it comes to studying the performance of government and the elected officials who oversee it.

There is so much to comment on here that I could go on well beyond your margin of attention. Out of frustration, I'm going to simply list a series of bullet points in response.

  • A "dedicated trust fund?"  Are you kidding?  You mean like the Highway Fund that is regularly raided to fund General Fund shortfalls?  Or are you gonna use a "lockbox" this time?  This provision has all the credibility of a free lunch.
  • Non-residents who maintain "significant contact" with the state are eligible for coverage?  Are you bonkers?  You're an attorney, Charlie.  I'd like to think you're bright enough to know such language and provisions are idiotic.  On the other hand, maybe you see the language as guaranteed full employment once you term out, representing clients who demand coverage because they sent a post card to you once a year to maintain "significant contact."
  • "The plan is funded by the Maine Health Care Trust Fund, a dedicated fund receiving payments from payroll taxes and payments from the General Fund or any other sources."  Pretty open-ended, don't you think, Charlie?  Are we supposed to have confidence in such loosey-goosey plans for funding?  Would this be a good time to move all our assets to off-shore accounts?  You know, the same kind Congressmen and others similarly unaccountable make use of.
  • Global budgets for health-care expenditures?  Can you say rationing, boys and girls?  Do you establish an annual "global budget" for your health and dental care, Charlie?   How about you, Stan; do you too?
  • Study the delivery and financing of long term care services to plan members?  Maybe my age is showing, but if nothing else, this sounds like it opens the door to rationing of care for the elderly.
  • Last but not least, a 7.5% tax on "wages and earnings," including self-employed earnings.  How about a more specific definition of earnings, Charlie?  Would that include payouts from 401k's, IRAs, and similar instruments?  How about pensions for state and local government employees?
That new tax ought to be a real boon to Maine's economic competitiveness and overall outlook for a bright future.  And I got to hand it to you Charlie.  You've been able to determine that it will take a 7.5% tax on wages and earnings to pay for this grandiose plan.  Not 7.1%; not 8.2%; exactly 7.5%!  Damn, you've really got a grasp of all the complexities.

Thousands or private and public sector "experts" have been grappling unsuccessfully with this probem since the last century, and here you've managed to come up with the exact answer in the context of one little old proposed state law.  But I do have a question.  What happens when Maine's total wages and earnings decline?  Will the tax go up, or will health care be rationed even more to fit within the revenue total?  And in the unlikely case that total wages and earnings increase, will the excess be refunded to taxpayers, or the rationing screws loosened up, or will the excess be used for General Fund pet rocks?

Aw, hell.  Look at me asking annoying questions about the details of your benevolent offering to a supportive and obedient constituency.  I should know better.

Actually, I do know better, and that is exactly why I'm asking these questions.  I hope you'll get back to me soon with the answers.  I'll be sure to relay them on to my hoardes of attentive and curious readers.

Oh, and one more thing, Charlie; wouldn't your time be better spent figuring out how to pay off the roughly half a billion dollars owed to instate hospitals and medical providers so that they have at least a snowball's chance in hell of surviving to tend to Maine's remaining population?  And just how much does it take to learn a lesson from the abject failure that is Dirigo?

As a friend remarked today, the bill has many far-reaching goals.  The only one guaranteed to be achieved is the 7.5% tax increase on earnings.  Perhaps that's the true purpose of the bill - to provide plausible cover for a broad based tax increase, more than doubling the tax on income.  That alone should have an enormous effect on the health of each and every one of us.

Good grief, Charlie Priest.  Time for you to spend a few nickels talking to Lucy; she might be the only one who can talk some sense into you.  Tell Lucy she can send me the bill; it can't amount to much more than peanuts.

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