When I started my family practice here in Maine in 1982, taking care of people in the way I thought best was pretty easy. Of course the costs were much less, but back then, insurance companies universally paid the bills. Deductibles and exclusions were relatively rare.

Fast forward nearly 40 years, and medical practice has been transformed by the supremacy of the insurance industry, which now calls the shots. Insurance, or the lack thereof, often has more to do with our practices than our training and professional judgment.

Although the Affordable Care Act did a great deal to expand coverage to millions of Americans, for many the deductibles and out-of-pocket costs are now prohibitive. According to federal data, insurance deductibles doubled between 2008 and 2017. Faced with this reality, many people do not or cannot come in for needed care, or can’t afford the drugs prescribed.

Twenty-five percent of the public struggles to afford their prescriptions. It is well known that Americans pay more for their prescriptions than anyone else. We are 4% of the world’s population, but we represent 45% of total pharmaceutical revenue.

Other countries’ governments negotiate or even regulate the costs of drugs so that those countries are basically paying generic drug prices across the board. Our government does not do this.

To protect their enormous profit margins, drug manufacturers delay or prevent drugs from going generic by tinkering with delivery systems or minor ingredients, and then raise those prices year after year. Drug prices in recent years have been rising at twice the inflation rate, far ahead of anyone’s growth in earnings.

We have to and can do something about this, and fast. That’s why, as a physician, I am supporting LD 1463: An Act to Make Health Care Coverage More Affordable for Working Families and Small Businesses. This bill would continue the federal health insurance assessment on a state level, and it lays out how it would use the potential $30 million in revenue to lower health care costs for Mainers.

This bill wouldn’t cost everyday Mainers. The health insurance assessment is simply a fee paid for by private insurers (that was recently discontinued) which allowed them to access the health insurance marketplace. By bringing it back on the state level, we can create the Maine Health Care Affordability Fund, which could provide financial assistance programs to help lower out-of-pocket costs and provide coverage for underinsured and uninsured Mainers. This would change my patients’ lives.

“Alex” is a 50-year-old patient of mine who works construction. He struggles at worksites because he cannot afford the inhaler he needs for his lung disease.

“Bernice” is a 67-year-old patient with diabetes that has already caused nerve and kidney disease. Insulin treatment has stretched her budget to the max. One of the newer classes of drugs has been specifically designed to prevent the progression of kidney disease to renal failure and dialysis — but the monthly cost would be like a second mortgage payment for her, even with insurance coverage.

“Chelsea,” a 32-year-old patient in opiate treatment, could no longer afford her addiction treatment when she lost her insurance. This led to her relapse, which in turn resulted in the loss of custody of her children.

The stories are as diverse as my patients, but the common thread is that my patients’ lives and livelihoods depend on having access to affordable and comprehensive health care. These big insurance companies are making more money than they need — by paying this fee, they would barely lose a drop in the bucket, but my patients could get the care they desperately need.

Dr. Stephen Bien of Jay has been a family practice physician in Maine since 1982.