Last week the New York Times ran a story with the headline “As Health Plan Falters, Maine Explores Changes.” The story described the gap between the high hopes for Maine’s Dirigo health plan (“Dirigo,” the state’s motto, means “I lead”) and the more modest realities. No one wants to hear that their efforts are “faltering”—indeed I don’t believe that is a fair characterization of what is happening in Maine—but perceptions are important and must be attended to.
One of the great strengths of the Massachusetts reform is its aggressive implementation timeline. Slow implementation schedules cause participants in the effort to lose their sense of urgency. Difficult issues can be are postponed. Positions can harden and delay becomes a negotiating tactic. The public and those on the edges of the reform coalition move on to the next issue, leaving only a core of committed folks to carry the burden of all the work that needs to be done. And, as Massachusetts learned well in the 1990s, implementation delayed can ultimately end in repeal of the reforms.
Of course rapid implementation has its risks as well.
Quick decisions can be ill-considered and the need for speed can be an excuse for shutting the public out of the decision-making process. But thus far the Connector Board has demonstrated a commitment to obtaining input and using the best available information even as it has moved forward on its ambitious agenda.
A critical component for ongoing success will be monitoring the reform’s progress. For most of the decisions the Connector has had to make, there is no “right” answer. There isn’t even much data or experience to look to for guidance. As decisions are made—products are put to market, individuals are confronted with the implications of the mandate—it will be critical to observe, listen and learn. There must be as much of a commitment to rapid mid-course corrections as there has been to rapid initial decisions.
The same day as the New York Times headline, I participated in a meeting in Rockland, Maine sponsored by the Maine Health Access Foundation and attended by more than 200 people. The title was “Advancing Health Reform in Maine.” Dirigo was enacted in 2003, and, indeed, in 2007, additional “advancing” is needed. Massachusetts should expect to need the same over the coming years.
Alan Weil is Executive Director of the National Academy for State Health Policy
This program aired on May 4, 2007. The audio for this program is not available.