Every dollar spent by any government comes out of someone’s pocket and must be spent wisely. That’s why it’s critical not to spend more than necessary, but also to spend wisely when it’s affordable and leads to outcomes that improve the state and create greater opportunity.
Hidden in those simple rules are many complexities. Who should get taxed more and who less? What’s the role of property taxes versus income and sales taxes? What makes a program affordable? And what helps our state promote opportunity? Still, when actual proposals are before legislators and voters, the choice boils down to going in one direction or another.
Maine people have diverse values. For instance, some believe government shouldn’t be involved in health care while others see health care as a right. And there are people who think government should help provide health care for a particular group of people.
But, ideally, we wouldn’t be divided in assessing the realities of programs and proposals. Which ones actually promote opportunity? Which approach leads to more or fewer preventable deaths? Which increase economic growth?
The view that there can be rational answers from investigation is the fruit of a great intellectual movement that gave us scientific revolutions, philosophical insights and immense creativity — the Enlightenment.
Unfortunately, Enlightenment values, the chief of which is a commitment to reason, are undermined by people’s unwillingness to challenge their own beliefs. Instead, psychological researchers have found that people with the strongest views often use “motivated reasoning,” which leads them to cling tightly to views that evidence simply doesn’t support.
In Maine, we’ve seen this in claims by opponents of Medicaid expansion that a lack of health insurance coverage doesn’t really matter for people’s lives. Despite the many top-quality studies published in the best journals of medicine, they reject the reality that lower coverage rates are associated with people dying of preventable disease.
Just compare statistics on women without insurance with those with coverage and you’ll see that more babies die in the first group, as do women who are pregnant or have recently given birth. It’s known that women without insurance are 60 percent more likely to have stage four cervical cancer than women with insurance.
Even a study expansion foes tout found a 10 percent higher rate of mortality for the uninsured.
Personal stories are also instructive. Decades ago, Sen. Angus King’s aggressive melanoma was caught early because he had insurance and went in for a checkup. Someone else with the same symptoms but no coverage would have died.
Meanwhile, the current expansion proposal, written by two Republicans, controls costs through managed care.
If Medicaid isn’t expanded in Maine, it would keep company with states with poor health outcomes and fewer insured people. Where are they? Well, if you got in a car and drove south, every state you traversed would have expanded Medicaid until you hit the Mason-Dixon line. Most non-expansion states are in the south.
Should Maine follow these states’ lead, it would give up 4,400 jobs and more than half a billion dollars in economic growth. Nearly $1 million a day that could be flowing in wouldn’t. And Maine could really use the economic boost.
Maine’s job growth is 45th in the country and all the net jobs in the last year have been created in either the Portland, Lewiston/Auburn or Bangor metro areas.
A lack of expansion would strain Bangor’s health care sector, a major source of the region’s jobs. So what do candidates for the Bangor-area state Senate seat say? Sen. Geoff Gratwick, a Democrat, strongly supports expansion, both because this physician-legislator sees its importance for patients’ health and opportunity and because of its impact on the local economy.
Meanwhile, the position of Republican Cary Weston is as clear as mud. According to reporter Michael Shepherd, “Weston said he supports expansion generally, but would only vote for it if convinced that it would help control existing runaway costs in the MaineCare program. He said he would have voted against this year’s expansion bill because he didn’t think it went far enough toward that end. Still, he called expansion the right thing to do.”
Members of the Legislature must weigh complexities, but don’t have the luxury of waffling. Ultimately they must choose.