Architects of the health-care summit that opens today in Annapolis hope to start the process that could provide affordable medical care to 570,000 uninsured Marylanders.
The sponsors say such a dramatic revamping of Maryland's medical-delivery system could make the state an example for the nation.
"I think it's a golden opportunity," says Del. Casper R. Taylor, D-Allegany, the chairman of the House of Delegates' Economic Matters Committee.
The planners hope to lay the groundwork for one of three systems that conceivably could give uninsured Marylanders access to medical care.
Whether the two-day summit can make any headway toward curing one of the nation's most intractable problems remains to be seen, but its sponsors appear convinced that Maryland is in a unique position to lead the way.
They cite Maryland's world-renowned medical facilities, such as the Johns Hopkins Hospital, and the success the state has had in regulating hospital fees. They point out that a successful solution for medical coverage here would have high visibility because it would take place on the doorstep of the nation's capital.
The reform of the American health-care system has become a hot topic in recent years and promises to be a key campaign issue in this year's presidential election. But most of the debate has been what to do on a national scale, not on the state level.
Then, about six months ago, Taylor went to a national governors conference and heard President Bush urge states to be "true laboratories of democracy" and to set up demonstration models of various health plans.
From that seed of an idea, Taylor decided that Maryland is in a unique position to be such a demonstration model.
The state's three options are being called the single-payer system, the play-or-pay plan and consumer choice. The general characteristics of each are:
* The single-payer system, which is modeled after the Canadian health program, would funnel all health-care costs through a single agency, or insurance company. The money for the system would come through taxes, and the entire population would be covered. Supporters of single-payer say the system is more efficient, allows people to select their own physicians and gives government control over health-care costs. Detractors say the system leads to rationing of health care and reduced quality.
* Play-or-pay would require employers to provide health-care insurance to their employees ("play") or pay into a fund that would supply coverage to workers without insurance. Small businesses have said this system would add an extra burden to their operations.
* The consumer-choice plan envisions a tax credit for middle- and lower-income individuals that could be used only toward purchasing health care. The lowest-paid workers would be provided the highest credit, which would provide basic coverage. Employers could pay for more health-care coverage for their workers, but the cost of this benefit would be added to workers' gross pay and they would pay taxes on it.
Supporters of the consumer-choice system say it is more equitable than the current system and would give consumers a choice of health-care plans. However, the system would not have the direct control over costs that the single-payer system would have.
Taylor is optimistic that state lawmakers can reach some agreement on what plan to pursue and to enact it during this General Assembly session.
"I think the legislative process can find a consensus," he says. "I'm anxious to give it the best shot we can give it."
The biggest obstacle, according to Taylor, would be if all the participants come to the process with their positions locked in. "Our first and immediate job is education and it's not going to be easy," he says.
He envisions the demonstration system running for two years. If a detailed examination at that time determines it to be a success, "we've hit a home run," Taylor says. If it flops, the process could be reversed and the current system reinstated.
While all three options would be considered by the legislature, Taylor favors the consumer-choice plan because it protects the middle class and preserves the right to choose a particular health-care plan.
The other two systems would be difficult to adopt or reverse, he says. The single-payer system would essentially put out of business the state health-care insurance industry, and the increased taxes under the play-or-pay plan would put small Maryland businesses at a competitive disadvantage with companies in other states, he says.
But even the consumer-choice program would require a change in the federal tax code to give Maryland residents a special tax rebate for the program -- something no other state has. "That's why we need the cooperation of the federal government," Taylor says.