The median U.S. household income has decreased 3.6 percent this year, yet health insurance premiums are projected to increase 9 percent nationally.  In Maine, Anthem wants a hike of 18 percent.  This outrageous news comes on the heels of a decade (from 2000 to 2009) when health insurance premiums in Maine rose 4.6 times faster than our household incomes!

Something is terribly, terribly wrong. Yet, notwithstanding the tireless efforts of Senator Snowe to achieve meaningful reform at the federal level, the health care debate in Congress appears to have sailed right past the most important point. We need to stop arguing about who pays and start thinking about what we are paying for!

A recent story in the Bangor Daily News reported on a new, low-cost health care plan that has been organized by a group of Rhode Island physicians.

“I’d do this tomorrow . . . ,” said Maine’s own Dr. Michael Clark of Damariscotta.  “To be able to deliver care to my lobstermen and carpenters and all the small businessmen . . . The big excitement is not to get a few more bucks per person. It’s to deliver care that aligns with my values and my conscience, and that is the care that our patients want.”

That is exactly the kind of care that we ought to be able to provide to everyone in Maine. And when I am governor, we will do that.

Whether we like it or not, and whether we realize it or not, we are all paying for each other’s health care today – and we are paying far, far too much for it. We are all paying high prices for unnecessary visits to hospital emergency rooms; we are paying billions of dollars in advertising, overhead and profits to health insurance companies; we are paying billions more to make up for the shortfalls in Medicare and Medicaid reimbursements; and we are paying for expensive treatments and remedies for conditions that could have been prevented.This is an unnecessary handicap on Maine’s working families, who pay too much and sacrifice too much in wages for health care, and it is a burden that is breaking the back of Maine employers, for whom high health care costs are one of the most important factors making it difficult to do business in Maine.

The Dirigo health insurance program was an important attempt at reform. It signaled Maine’s intent to make essential health care services accessible to all. It was well-intentioned, but it just didn’t work as intended. It covers too few of those who need coverage, and it does so at too high of a cost. We need to replace it with something better and more cost-effective.

We also need to lower Maine’s high Medicaid expense, which is way, way above the national average, primarily because of unusually broad eligibility and a scope of services that is far beyond what is available in other states. Instead of programs that aren’t working and insurance coverage that is beyond our means, we can fashion a broader program that provides access to essential health care services for all Maine citizens at a price that Maine businesses and taxpayers can afford.

We can make health care in Maine work . . . for all of us. To do so, we need a focused strategy based on three important principles.

• First, all Mainers should have access to essential health care services. We need to protect people from the ruinous economic consequences of unanticipated illness, the leading cause of personal bankruptcy in our state and in the country, so adequate coverage must include coverage for catastrophic illness. We must not forget that the reasons why Medicaid coverage in Maine is so broad and why we conceived and enacted the Dirigo program were good and sound reasons; we are compassionate, generous and decent people in Maine, and we should not desert those principles.

• Second, however, our program must be fiscally sound. We need to draw bounds around what we can afford to provide. We no longer can afford to indulge our very best instincts – our compassion, generosity and decency – without regard to what it costs to do so.

• And third, we have to stop paying for procedures and start paying for good health. We can develop a program that learns and borrows from the highly successful efforts undertaken by Cianbro, Hussey and some of Maine’s other large employers; one that builds on Maine’s strong systems of non-profit hospitals, committed physicians and caregivers, and one that incentivizes and pays for healthy behaviors and healthy outcomes. Many of the diseases we pay to treat are preventable. We need to create incentives for people to stop smoking, to lose weight and to take better care of themselves. That is the only way that we are going to bring costs under control, and it is the only way as a society and as a community that we will be able to afford broad access to essential care.

Maine can work.  Providing high quality, affordable health care for every citizen is one of the biggest levers we have to lower the costs of living and doing business in Maine . . . and it is one of the most important ways in which we can make sure that Maine works for all of us.