LEWISTON – Smarter consumerism is one answer to Maine’s high costs for health care, the executive director of the 18-month-old Maine Health Access Foundation told several dozen attendees at Thursday’s Great Falls Forum.

“We don’t really offer health insurance on an equitable basis here in the United States,” Wendy J. Wolf told the noontime audience at the Lepage Conference Center at St. Mary’s Regional Medical Center. Wolf urged health care consumers to seek second opinions and alternative treatments whenever possible.

She said the Maine Health Access Foundation supports universal access to health care, but “we don’t know the answer to getting there.”

“Health care in America is a mishmash of a lot of things,” Wolf said, pointing out that consumers have been led to have great expectations because of medical technology, but costs are often highest for those who are uninsured and least able to pay. Wolf blamed that burden on cost shifting when insurance companies increase premiums to make up for shortfalls in government payments for Medicare reimbursement.

“Sometimes the enemy is really us,” Wolf said as she explained how Maine’s demographics work against medical cost control. There are more and more overweight and older people in the state, many of whom smoke, she said.

In response to a question from a man in the audience, Wolf agreed that debate over “rationing” of health care must take place.

“I prefer to call it basic versus Cadillac,” she said.

Wolf said a Medicare study showed that “the higher cost was where there were more doctors, more hospitals and more services. If you’re in that setting, things are going to happen. Things are going to get done to you, sometimes not always things that we need to be doing.”

Nevertheless, “we shouldn’t let the whole scheme of providing every service for every condition for every cost get in the way of providing something that is good for everyone,” she added.

Addressing another question, she said she thinks lower Canadian prescription drug prices “are a market dynamic,” and said she agrees it’s not fair.

“Health care does not really have any business being a business,” Wolf said.

“I’m a physician. I went into medicine because I felt medicine was a philanthropic calling,” she said. “I didn’t go into medicine because I thought it was a business.”

She also voiced blunt criticism of advertisements by pharmaceutical companies on TV and in the print media which push expensive products that doctors sometimes haven’t researched. She related a personal experience when her doctor wanted to prescribe a new product for her, but she said he didn’t have facts on its use or cost.

Regarding hospital ads, she said, “I think that advertising for the most part is just trying to get a bank of business into a facility.”

She said, “I want you to know where to get the best quality care, but most advertising is not that.”

Wolf explained how the Maine Health Access Foundation provides grants throughout the state, including nearly $200,000 for the Bates Street Family Health Center in Lewiston. The foundation’s funding resulted from the sale of Anthem/Blue Cross several months ago. Because that insurer was a nonprofit organization, the share that went to the foundation can be seen as compensation for tax breaks that had been granted, she said.

Before coming to Maine, Wolf helped develop, coordinate and implement federal policy and operational guidance for the $24 billion State Children’s Health Insurance Program.

She received former U.S. Department of Health and Human Services Secretary Donna E. Shalala’s Award for Distinguished Service in May 2000.

The Great Falls Forum is a monthly public presentation sponsored by the hospital, Lewiston Public Library and the Lewiston Sun Journal.