Maine Gov. touts market-based healthcare solutions for rural America

Maine Gov. Paul LePage (R) told an enthusiastic crowd at the Heritage Foundation on Monday that his Republican administration thinks "taking off the shackles" from insurers is the way to keep healthcare costs low for rural residents.

LePage is among the state leaders who have vowed to repeal Democrats' healthcare reform law and replace it with market-based solutions, such as allowing people to buy cheap insurance that's not as comprehensive as called for in the law. Maine has recently sought to pare down its Medicaid program, forced out its Democratic-appointed insurance commissioner and allowed residents to buy insurance from other New England states.

LePage defended his decisions to deregulate the insurance market with his trademark dry humor and a story about regulations that force nuns to buy maternity care.

"We should have exempted the nuns," he said. "Then if they got into trouble, we could call the Pope."

Lepage said his experience living in Canada — an apparent reference to his years working for a lumber company in New Brunswick from 1972 to 1979, when he was in his 20s — showed him the shortcomings of government healthcare. He said people with chronic diseases simply could no longer live miles away from the nearest hospital, and had to move.

LePage's criticism of Canada's rural healthcare system has some merit.

An extensive 2002 report revealed that rural residents had a worse health status than urbanites and access to a smaller range of healthcare providers, while rural hospital closures and centralization of health services had had a severe impact on rural residents.

"If there is two-tiered medicine in Canada," John Wooton, Canada's then-special adviser on rural health, wrote 10 years ago, "it's not rich and poor, it's urban versus rural."

Those disparities are just as prevalent in the U.S.

The Center for Rural Affairs in Nebraska reports that rural Americans are more likely than urbanites to be uninsured and more likely to be on Medicaid and other government programs than urbanites, while receiving less care. 

"Despite an older population and higher rates of disability in rural areas — which should require higher health care needs — rural residents actually receive comparable or less care in many measures, suggesting rural residents may not be receiving adequate care," the center says. "For example, rural residents receive fewer regular medical check-ups, blood pressure checks, cholesterol checks, pap tests, and mammograms than they medically and statistically should."

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