Douglas Rooks has been a Maine editor and columnist for 41 years. His biography of Gov. Ken Curtis, “Transformational,” is now available. He welcomes comment at [email protected].
Probably not one in a thousand Mainers could identify the CEO of MaineHealth, which has more than 22,000 employees and, as a Forbes magazine profile puts it, “is the largest health system in northern New England” providing care for “1.1 million residents in Maine and New Hampshire.” It owns nine hospitals — 10 starting in October, when it takes over York Hospital, a rare independent holdout.
Yet Dr. Andrew Mueller, that CEO, is more powerful — or at least has more control over healthcare — than both the governor of Maine and a nominee to succeed her.
For months, a public campaign has been waged over proposed elimination of the birthing unit at Lincoln Hospital’s Miles Campus in Damariscotta. A dozen birthing centers have closed at Maine hospitals in a decade, most recently in Houlton, leaving a large geographical gap in where families can get pre- and post-natal care.
Women in the Miles community made a stand, and didn’t just oppose closure. They proposed a plausible plan where MaineHealth could use nurse midwives and other qualified staff instead of relying exclusively on obstetricians, who’ve been in short supply for decades. While there are fewer births at Miles than 20 years ago, there are many more than five years ago, when community efforts to rebuild the program began.
Advocates also asked that a final decision be delayed — a suggestion taken up by candidate Hannah Pingree and then Gov. Janet Mills.
Instead, the MaineHealth board slammed the door and closed the unit — although it pledged, for what it’s worth, no more closings for two years. This could be rightly viewed as a slap in the face to Maine’s elected leaders, who have approved hundreds of millions of state and federal Medicaid dollars; the Mills administration has been good for hospital bottom lines.
But that’s not enough to save birthing centers. Board members no doubt believe theirs was a responsible decision — which says more about the relentless financialization and commodification of American healthcare than any number of reports and analyses.
Mueller attempted to justify the closure by saying the hospital couldn’t provide “the clinical team necessary to deliver safe care every hour of every day.” This sets an impossible standard, one that treats even routine deliveries as a “medical event.”
Rather than seeing hospitals as community institutions, dedicated to serving local needs, our system treats them as cogs in a vast machine. Local boards that might have made a different decision are long gone.
The Affordable Care Act — the only major attempt to rationalize healthcare in decades — is in danger of failing. For a time, Americans could buy subsidized insurance, with low-income families covered by Medicaid. Then came the One Big Beautiful Bill Act last year, with drastic subsidy cuts — 5 million have dropped their coverage — and punishing reductions in Medicaid.
Sen. Susan Collins touts the rural hospital fund in the same bill without mentioning Maine will lose at least three times as much through cuts as it could gain, and even that depends on Trump administration approvals. The first $30 million grant for rural Maine hospitals is for — you guessed it — greater “efficiency.”
American healthcare has reached a state of complexity, all in the name of efficiency and accountability, that baffles even those charged with administering it. Families worry daily over whether services are covered, and hospital bills are indecipherable.
It wasn’t always like this. Sen. Olympia Snowe, Collins’ former Republican colleague, worked hard to allow rural hospitals to remain independent, but now the pace of centralization, and demands of insurers and drug companies that also receive billions in public funds, have created a system few can navigate and even fewer understand.
We’ve heard too many times of doctors fighting with computer programs over medically necessary treatments, of front-line workers burning out, of patients who face bankruptcy. Considering that Americans already pay more than any comparable nation for healthcare, it would seem none of this is truly necessary.
And it isn’t. If we embrace the concept that every other civilized country has adopted — a national system, planned and supervised by the federal government — we could solve most of these problems. Universal coverage, no consumer billing and easily understood, standardized treatment options can be achieved.
This formerly radical idea, now going by the slogan Medicare for All, is front and center in this year’s campaigns. It may be our last, best chance to achieve what we should have had all along.
Then we could look to a day when families bringing children into the world could have the support necessary if we truly want to have a state that values them. May we vote wisely.