O pioneers!

January 12, 2007

As Maryland's lawmakers once again try to close the gap between health care haves and have-nots, they owe a big debt to counterparts in other states who have already ventured onto this perilous turf.

The most recent adventurer is California Gov. Arnold Schwarzenegger, who seems every bit as bold a policymaker as he ever was an action movie star.

Pledging to provide near-universal health care, he is following the Massachusetts model that declares medical coverage is not only a right but a responsibility. Combining individual, employer and public contributions toward the goal of improving overall community health, this approach is expected to save money in the long run because healthy people are cheaper to insure.

This theory is still so young that no clear conclusions can be drawn, even on the key question of whether such a sweeping program must be adopted all at once or can be successfully bitten off in small, more politically palatable pieces.

Intriguing information is emerging, though, that Maryland legislators should consider. For example:

Universal coverage can be reached more quickly with a solid base of Medicaid coverage for low-income adults above the poverty line as well as children. Such a program in Massachusetts left only 7 percent of the population without coverage. In California, the uninsured make up one-fifth of the state; in Maryland, about one-sixth.

Mandates of any sort must be both attainable and enforceable. Low-income individuals need subsidies to purchase policies; small employers need tax incentives and access to group markets.

The private market of providers and insurers must remain in force to set prices and ensure quality through competition. Yet there must be a means of negotiating the best bargains for consumers.

A variety of insurance plans should be available. Major drivers of cost in Maryland include mandated benefits and coverage that prevent offering no-frills policies.

A cultural change may be required for those who believe health care is available to them only in the emergency room, and those who consider it a reasonable item on which to scrimp.

Providing universal health care is complex, controversial - and critical to a thriving society. But every step into the unknown by these pioneers teaches valuable lessons. Maryland's lawmakers and leaders would do well to learn them.

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