The insurance component of the Dirigo Health Reform Act is only part of its overall design. In addition to establishing a new government health agency (the Dirigo Health Agency) and government-run health plan (DirigoChoice), the measure
- requires the development of a State Health Plan–a first draft of which was issued in May 2004–that will “strategically guide future investments in health services statewide” by setting “a global budget to direct public and private efforts to meet those needs within the resources available”; and
- establishes the Maine Quality Forum, which will advocate for “best practices” and “evidence-based” medicine as well as assess medical technology needs in the state so as to “inform the Certificate of Need process” and avoid “waste of equipment, supplies, ideas, and energy.”
The increased government oversight of health care investments and global budget provision concern Adam Brackemyre, executive director of the Coalition Against Guaranteed Issue. “While Dirigo requests hospitals and other providers to limit their cost growth to 3 percent per year and insurers are asked to limit their operating margin to 3.5 percent,” he noted, “human health and blizzards are not predictable.” Maine’s population generally scores lower than average on most national measures of good health.
William H. Beardsley, president of Husson College, wrote in the August 28 issue of the Bangor Daily News, “A current Maine solution appears to centralize decision-making and planning, expand government certificate-of-need regulation to reduce wasteful duplication of effort, and extend the current single-payer system for teachers and state government employees to all Mainers covered by Dirigo Health.
“But, what if the certificate-of-need, single-payer insurance system, and state planner’s cures are worse than the pain?” Beardsley asked. “What if these cures result in ever-more health monopolies and constraints of trade, disappearance of health care in rural towns, disappearance of competition in Maine cities, higher rather than lower costs for MRI’s and similar procedures, and higher premiums for insurance because competition is all but gone?”