Health Care Reform Paper

Maine Medical Association Statement on Reform of the U.S. Health Care System

Background:  The Maine Medical Association has participated in the public policy debate about health care reform for many years.  The MMA adopted Resolution #8, Health Insurance Coverage at its 2002 Annual Session.  The MMA approved Providing Coverage to All:  MMA’s White Paper on Healthcare Reform in Maine on May 1, 2003 and reaffirmed that White Paper on July 15, 2009.  The MMA supported Maine’s Dirigo Health Program legislation, L.D. 1611, An Act to Provide Affordable Health Insurance to Small Businesses and Individuals and to Control Health Care Costs (P.L. 2003, Chapter 469) in 2003 and the Patient Protection & Affordable Care Act (PPACA or ACA) in 2010 as incremental steps towards the goal of health care reform.  The MMA recognizes that the public policy debate about the future of the U.S. health care system continues to be the most dynamic since the establishment of the Medicare and Medicaid programs through enactment of the Social Security Act of 1965 more than fifty years ago and that it is an important part of MMA’s mission to help educate its members about the topic and to facilitate a dialogue among members about the topic.  During the past decade, the MMA has polled its membership twice on the topic of health care reform.  A 2008 poll of MMA members revealed that 52.3% of respondents preferred “a single-payer system such as a ‘Medicare for all’ approach” when asked about the topic of health care reform while 47.7% of respondents preferred “to make improvements to the current public/private system.”  A 2014 poll of MMA members revealed that 64.3% of respondents preferred “a single-payer system such as a ‘Medicare for all’ approach” when asked about the topic of health care reform while 35.7% of respondents preferred “to make improvements to the current public/private system.”  The MMA convened an Ad Hoc Committee on Health Care Reform in June 2016 to develop a current policy statement on health care reform.  The Ad Hoc Committee has produced this draft policy statement and presented it to the Board of Directors.  The membership of the Ad Hoc Committee follows:



  1. Hani T. Jarawan, M.D., Chair, Portland
  2. Maroulla S. Gleaton, M.D., Palermo
  3. R. Scott Hanson, M.D., M.P.H., Lewiston-Auburn
  4. Jabbar Fazeli, M.D., Portland
  5. Paul R. Cain, M.D., Lewiston-Auburn
  6. Philip Caper, M.D., Brooklin
  7. Cathleen London, M.D., Robbinston
  8. Richard B. Swett, M.D., Dover-Foxcroft
  9. Thomas R. Sneed, M.D., Readfield
  10. Samuela E. Manages, M.D., F.A.A.F.P., Saint David
  11. Lani Graham, M.D., M.P.H., Freeport

The Maine Medical Association (MMA) is a professional organization founded in 1853 and headquartered in Manchester, Maine representing more than 3900 physicians, residents, and medical students whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA believes that the current U.S. health care system continues to produce some of the world’s most eminent clinicians and health care facilities who together provide some of the most advanced medical care in the world.   But, it does not provide basic health care as well as many other developed countries and, therefore, is not serving our country or its people as well as it should.  We face the problems with our current health care system in our daily encounters with patients.  We believe that the United States can and must do better in providing health care to its people.

Our objective should be to achieve basic health care for every resident of Maine, regardless of age, gender, race, place of residence, occupation or lack of it, employment status, health status, income or wealth status, or legal residency status. 

We support the “Quadruple Aim,” a framework developed by the Institute for Healthcare Improvement describing an approach to optimizing the performance of our health care system.  These core values are:

  1. Improving the patient experience of care, including quality and satisfaction;
  2. Improving the health of populations;
  3. Reducing the per capita cost of health care; and
  4. Improving the health and work life of health care clinicians and staff members.

Our health care system should strive to incorporate the following principles:

  1. Provide health care that is patient-centric and physician-directed. 
  2. Put the patient first and protect the sanctity of the physician-patient relationship, particularly respecting the physician’s autonomy as advocate for the patient.
  3. Promote the maximum possible choice in patients’ selection of physicians.
  4. Support a strong and vital public health infrastructure that can collaborate fully with physicians and the health care system to advance population health.
  5. Emphasize prevention and provide systemic support for healthier lifestyles, through incentives for identified health risk avoidance.
  6. Be politically sustainable by including everyone as a participant and, therefore, a stakeholder in supporting it.
  7. Be simple and fair, such that every participant can understand it and perceive that its financing burden and benefits are distributed fairly.
  8. Stress pooling of clinical risk rather than medical underwriting.
  9. Be efficient and have the ability to restrain rising health care costs at a system-wide level in the least intrusive way possible.
  10. Have the ability to integrate and coordinate services in order to reduce fragmentation and the division of medical care into “silos.”
  11. Improve quality and minimize errors by relying upon evidence-based medicine, benchmarking, and outcome measures driven by clinicians and administrators working together.
  12. Promote transparency of health care cost, quality, and outcome data.
  13. Reduce the burden of administration to the greatest extent possible and include a billing system that is streamlined and consistent, as well as a payment system that is prompt and outcomes oriented.
  14. Make health information technology (HIT), including electronic medical records (EMRs), more user friendly and more focused on clinical matters, rather than financial matters, and completely interoperable in order to facilitate rather than impede communication and work flow among clinicians, patients, and health care facilities.
  15. Include a rational means of resolving medical liability disputes in order to restrain defensive medicine.