Roger Poitras is CEO of InterMed.
Most of us learn early in life: don’t make medical decisions without consulting a health care professional. When it comes to shaping health care policy, we don’t always follow the same advice, but we should. And in Maine, we’re beginning to.
Our health care system is under real strain. Across the state, hospitals and medical practices are operating with thin margins, struggling to recruit and retain staff and making difficult decisions about which services they can sustainably offer.
Workforce shortages and rising costs are colliding with an aging population and growing demand for care. These pressures create uncertainty both for organizations trying to plan ahead, and for patients who worry about access, continuity and how far they’ll have to travel to receive care.
Against that backdrop, Maine convened a commission to examine how the state reviews major changes in health care. I had the honor of serving on that commission, and the experience was enlightening.
The process was thoughtful and grounded in a genuine commitment to ensuring patients and communities have access to care. Nonetheless, the experience also reinforced an important lesson: effective reform requires more than convening a group and hearing testimony; it requires expertise and the willingness to listen to those who live these realities every day. It also demands a sustained, two-way dialogue and a willingness to wrestle openly with perspectives that challenge initial assumptions.
There were times throughout the course of the commission that the discussion felt oriented toward validating specific solutions rather than fully examining the underlying problems they were meant to address. Given the commission’s scope and timeline, that structure is understandable. But it also points to a broader risk in health care policymaking: when discussions begin with conclusions rather than questions, the range of viable solutions can narrow before the work truly begins.
Health care does not operate in silos. Clinical decisions affect staffing. Staffing affects access. Access affects finances. Regulation touches all of it. When policy is developed without engaging in that full context, it can be well-intentioned but incomplete, or responsive in theory but difficult to implement in practice.
Meaningful reform depends on processes that invite not just agreement, but challenge, nuance and the lived realities of delivering care. This commission showed that Maine is willing to invite frontline voices into the conversation. That matters. But if we want policies that truly strengthen our health care system, the state must continue to invite health care professionals into the conversation earlier and more consistently.
At the same time, those of us who work in health care have a responsibility to join the conversation. This commission was my first experience serving in this type of role, and to be candid, it was not always comfortable. At times, the process felt constrained.
The outcomes are not guaranteed. But participation matters. If we choose not to engage because the process is imperfect, we leave critical decisions to those farther removed from day-to-day care.
The future of health care in Maine will be shaped by who shows up, who stays engaged and who is willing to offer practical, experience-based insight, even when it complicates the conversation.
It’s time to deepen the dialogue, broaden participation and create an ongoing partnership between policymakers and the people who deliver care. That is how we move from conversation to action, and how we ensure Maine’s health care system remains accessible, sustainable and centered on the patients and communities it serves.
