Making a Good Health Care Plan Great For Maine

Steve Benen linked over the weekend to a Bangor Daily News account of an Olympia Snowe health care forum in which the Senator sounded very open to potentially far-reaching reforms:

“We have a totally dysfunctional system now,” she said. While like most Republicans she would prefer to see the private sector collaborate on an effective change, a government-run health care system may be the only way to get the job done, she said.

Ezra Klein observes that Snowe is a little bit lacking in the coherence department:

Snowe’s position is a bit of an odd one: She holds that we may require a single-payer system but probably should have a public insurance option. The next step, she says, is to fix the market. And Snowe argues that it’s not clear that you can do that with a public insurance option. She’s raised the possibility that the public plan is actually too easy on private insurers. It’s a government plan, she says, and every lobby and advocacy group will exert pressure for it to cover every ill, ailment, and treatment. As such, the plan will quickly prove a better deal for the sick than the well, and it will end up being the equivalent of a “bad bank” for health risks. The private insurance market will simply skim off the healthy. In other words, the public plan wouldn’t compete with the private market so much as subtly subsidize it.

I would say that the main thing in this sort of situation is to stop thinking about the big issues, and start thinking about little ones. How can you structure a health care program so as to be very beneficial to the state of Maine? It’s not genuinely the case that inadequate levels of subsidies to sparsely populated rural states are an important failing of the current American health care system. But with the two “most likely to swing” Republicans coming from Maine, the Chairman of the Senate Finance Committee coming from Montana, and the head of the Senate Budget Committee coming from North Dakota this is probably the shortest route between the status quo and major reform. The major question becomes whether or not significant, broad changes like a meaningful public option can be structured in such a way as to be appealing to these constituencies. Maine’s a weird state, maybe it needs blueberry subsidies or provisions that take into account the special needs of states with large seasonal swings in population.