Backed by his mayor and the state's medical society, Baltimore's top public health official launched a campaign yesterday to entitle all Maryland residents to health insurance and replace private coverage with benefits paid by a single state agency.
In the opening phase of an educational and political effort that could last years, Baltimore Health Commissioner Peter Beilenson released the results of a poll showing most Marylanders are disenchanted with managed care, fearful about future access to doctors and supportive of universal coverage.
Public health advocates have long argued that removing barriers to basic medical services would allow doctors to prevent expensive medical emergencies caused by chronic conditions left untreated.
Beilenson said the ultimate goal of his group, Maryland Citizens' Health Initiative Education Fund, is to bring about a single-payer system that could intercept billions of dollars of profits and administrative expenses collected by a welter of private health plans and redirect the money into care for more people.
The same fees would be paid for all patients, rich and poor, and doctors would find it profitable to serve impoverished areas that now are unable to attract physicians.
Beilenson interprets the poll results as an endorsement of the concept--and a potent political issue in the next gubernatorial election.
"They do want a simplified system," Beilenson said. "Insurance companies are denying too much care and putting up too many obstacles. Patients just want to be able to see the provider of their choice."
About 78 percent of those surveyed agreed that every Maryland resident should be entitled to comprehensive health coverage, and 87 percent said they support insurance for all employed people. Maryland has a large and growing number of residents without health insurance--more than 700,00--including many who work at low-wage jobs for employers who cannot afford to offer benefits. Nationally, about 44 million citizens are without health insurance.
But any such plan faces daunting obstacles, like the ones that killed President Clinton's health reform efforts in 1994. Apart from insurance industry resistance and public suspicion of government involvement in personal health matters, Maryland would risk becoming a single-payer island surrounded by private insurance markets.
"I would doubt any one state could move to this unilaterally," said Fran Doherty, vice president of governmental affairs for CareFirst, the parent company of Maryland Blue Cross-Blue Shield. "This is certainly an issue that must be addressed at a national level. If Maryland did it alone, it would find itself at a tremendous disadvantage."
Doherty said the private market can insure more people.
"I would hope that instead of taking drastic steps such as this there would be the ability to work together to try to address affordability and accessibility of health coverage," she said.
Donald Wilson, chairman of a state commission on health costs and dean of the University of Maryland medical school, said everyone supports expanded health coverage, but cost remains the major obstacle.
"If you're going to have universal coverage, you need to make it affordable," he said. "You need a limitation on benefits, and that's something a lot of folks have difficulty understanding. It wouldn't be just a wide-open package of benefits."
Nonetheless, Wilson, an appointee of Gov. Parris N. Glendening (D), said Maryland has a long history of being more willing than other states to regulate health costs and access, and he thinks Beilenson eventually could find enough General Assembly support to make a spirited debate.
Beilenson said his group does not yet have concrete proposals to present to political leaders.
Beilenson said there is no reason a sitting public health official should not participate in this kind of private effort, and he noted that Baltimore Mayor Kurt Schmoke (D) strongly supports his group.
"It's very much in line with my job," he said. "This is the most important thing I've done in seven years in the job."