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Maine leads the way toward universal access to health care

Just behind John Baldacci's desk, under dutiful portraits of the first Maine governor and his wife, there's a small plaque with a question carved into the wood: "What have you done for the people today?"

This is not the quote of a great philosopher or some modern pollster. It's what Baldacci's father, a JFK Democrat and Italian restaurant owner from Bangor, used to ask, with needling humor, when his son came home from a long, hard day of lawmaking.

If all goes well, Gov. Baldacci will have a pretty decent answer. Maine has just become the first state in the union to approve a plan to provide universal access to affordable health insurance.

In lean times, when other states with budget woes are cutting health care, Maine legislators voted to expand it. They did it in an older, sicker, poorer, rural state that won the dubious achievement award for the fastest growing health care spending per capita in the nation. They did it in a state in which 130,000 people are uninsured on any given day.

Baldacci, a lean runner sitting in a wooden rocking chair to favor his bad back, was a state legislator for 12 years and congressman for eight before being elected governor last November. He remembers when he would come home from Washington and talk about the only health care bill then on the federal docket, the Patients' Bill of Rights. Someone would say dryly, "That's all fine if you have health care." He'd talk about taxes to business people and they'd say, "taxes are a problem, but health costs are killing us."

Baldacci viewed health care as an issue at the intersection of what he unabashedly calls social justice _ "It's part of the compact we need to reward work" _ and good business.

After the election, Baldacci drafted Trish Riley to craft the overhaul. Riley has spent 25 years working on health care reform at the state level because "too many people get up and go to work every day and can't get coverage, and that isn't fair." She shared the governor's belief that the states can do what the federal government hasn't done.

"In Washington, they use bazookas on each other," says Baldacci, "They figure out ways not to make things happen." By comparison he lauds Maine as a less partisan, more collaborative state. Indeed, this is where a Democratic governor and two Republican senators _ Olympia Snowe and Susan Collins _ could fairly be described as independents.

Remarkably, Riley and Baldacci managed to get all the players _ hospitals, insurance companies, businesses, doctors, nurses, consumers _ to stay at the table. They worked for an agreement they hope will win the triple crown _ keep costs down, provide quality care and offer universal access.

The result is the creation of Dirigo, named optimistically for the state motto _ "I Lead." It's not exactly a humble moniker but it has better implications for health care reform than the motto in neighboring New Hampshire: "Live Free or Die."

Dirigo defies 30-second sound bites or three-sentence explanations. It folds in cost controls on hospitals and insurers with subsidies for low-income consumers and enticements to small businesses to buy insurance at lower rates. All this with a promise to improve the quality of health care.

One central feature would take the money that hospitals and health care providers already lose through treating uninsured patients _ who typically come in later and sicker _ and use it to help subsidize insurance. The governor also wants to tackle everything from the health habits of citizens _ smoking, fitness and fatness _ to the habits of hospitals that resist pressures to reallocate resources.

The big question is whether it will work. The compromise left cost controls largely voluntary. It's still uncertain how many businesses will sign up. And universal coverage will become universal only at the end of five years.

Nevertheless, it's astonishing what's happened in a matter of months in Maine. Across the country there are 41.2-million uninsured, 1.4-million more than last year. The fact that universal health care isn't even on the agenda is a stunning failure. The only "reform" to come out of Congress this year are two crazy-quilt Medicare prescription drug plans likely to leave as many elders in the cold as under the coverage.

As Baldacci says, without a hint of nostalgia for his days on Capitol Hill, "The hardest thing in Washington is to get people together for a common solution. It's easier to fight something than to do something."

So, leadership, that old Dirigo of an idea, may only come from the states. What did you do for the people today? "We hope people will ask, if Maine did it, why can't we do it?" says Baldacci, who predicts, "Maine may be the first state but not the last."

+ Ellen Goodman is a Boston Globe columnist. +

Washington Post Writers Group