MAINE: A HEALTH CARE WARNING

NY Times - Maine is the Charlie Brown of health care. The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon - solving one problem while worsening another.

But like the Peanuts character, the state keeps trying. . . Maine's history is a cautionary tale for national health reform. The state could never figure out how to slow the spiraling increase in medical costs, hobbling its efforts to offer more people insurance coverage. Many on Capitol Hill have criticized national reform legislation for similarly doing little to tame costs. . .

To be fair, Maine's reform efforts have had benefits. The state's Medicare beneficiaries get relatively high-quality and low-cost care, and the share of those who have no health insurance is lower than those of all but six other states.

But a state-sponsored insurance plan has been capped at fewer than 9,000 because of financing problems, and the most common choice of those buying new plans in the state requires them to spend at least $15,000 a year before the insurer pays anything - leading many to avoid important medical visits. . .

Another change Maine has tried is to expand its eligibility rules for Medicaid, the government program for the poor. Nearly a quarter of the state's population participates in the poverty program. Proposals on Capitol Hill would require similar expansions across the country.

But Maine's poor are among the sickest in the nation, and its Medicaid benefits are relatively generous. Only Alaska spends more per adult Medicaid beneficiary. Part of the reason may be that, because premiums in the private insurance market are so high, many go without insurance for years before qualifying for Medicaid. . .

To compensate for such expensive care, the state pays doctors and hospitals relatively skimpy fees for treating Medicaid patients. As a result, doctors are closing solo practices and joining hospitals, which then have the market power to jack up rates to private insurers in a common problem called cost-shifting.

Clinics for the poor - some affiliated with hospital networks - are thriving because they are federally supported. Maine now has 19 such clinics serving 200,000 people - a fifth of the state's population. The largest of them is Penobscot Community Health Care in Bangor, which has three cheerful, green-roofed buildings on its main campus, 126 medical providers and last year served 45,000 patients.