Jeffrey S. Barkin, MD, DLFAPA, is a practicing psychiatrist in Portland and the former president of the Maine Medical Association. He co-hosts “A Healthy Conversation” on WGAN.
On Election Day, most of us walk into the voting booth carrying more than a pen. We carry our families, fears, hopes, frustrations and memories of what went wrong the last time someone in power promised help was on the way.
In Maine, politics is still personal. We see candidates at diners, parades, church suppers, town halls and ball fields. We know their cousins. We went to school with their neighbors. We may have treated their parents, taught their children or sat beside them at a high school basketball game. That closeness matters. It keeps public life human.
Most candidates, regardless of party, are decent, sincere people. They run because they care. They knock on doors in bad weather, miss family dinners and take criticism most of us would rather avoid. We should not demonize them. A person can be wrong on policy and still be honorable. A person can disappoint us and still have entered public life with good motives.
But liking someone is not the same as trusting them with power.
Our job is not simply to ask, “Do I like this candidate?” Our job is to ask, “Will this person actually do what Maine people need?”
Nowhere is that question more urgent than in healthcare.
Healthcare is not an abstract policy issue. It is not a chart, a slogan or a promise buried in a campaign website. It is the difference between getting a mammogram now or a year from now. It is whether a rural hospital keeps its emergency department open. It is whether an elderly widow can remain safely in the home where she raised her children. It is whether a parent with depression finds treatment before the illness swallows the family. It is whether a doctor spends the afternoon caring for patients or arguing with an insurance company.
I met a man I’ll call Peter. He lived in a small Maine town where people still stop at the post office to talk. He was neither poor enough to feel safe nor wealthy enough to feel secure. He had worked all his life, paid his taxes, fixed his roof, plowed his driveway and expected little from anyone. When his wife developed a serious illness, he discovered that being insured did not mean being protected.
The bills came in waves. First the deductible. Then the copays. Then the out-of-network charge. Then the medication that was “covered,” but only after prior authorization, appeal, delay and paperwork no sick family should face. Peter was not asking for luxury. He was asking for time with his wife not consumed by hold music, denials, password resets and fear.
When I asked what it felt like, he did not talk about politics. He said, “I feel like I did everything right, and now the system is waiting for me to give up.”
No candidate should speak about healthcare without answering for Peter.
What will you do when insurance coverage exists on paper but collapses in real life? What will you do about prior authorization that wastes physician time, delays care and turns sick people into clerks? What will you do about hidden healthcare inflation, where premiums rise, networks shrink, deductibles grow and families are told to be grateful because technically they have coverage?
These are not partisan questions. They are Maine questions.
A candidate who says “the market will fix it” should explain how a patient in rural Washington County is supposed to shop for emergency surgery in the middle of the night. A candidate who says “government will fix it” should explain how new rules will avoid crushing hospitals, clinicians, nursing homes and community practices already operating on thin margins. A candidate who says “we support healthcare workers” should explain how, not just say it.
Good intentions are not enough. In healthcare, a vague promise is not harmless. It becomes a delayed appointment, a closed bed, an unpaid bill or a daughter driving through the dark because no one else is available.
Another patient, whom I will call Linda, was a retired school secretary. She had a warm smile and the kind of neat handwriting that made every birthday card feel like a gift. After her husband died, she lived alone in the house they bought as newlyweds. She wanted to stay there. That was not stubbornness. It was identity. His tools were still in the cellar. Her kitchen calendar still had family birthdays written in ink. Her lilacs still bloomed by the steps.
Then her health began to fail.
She needed help with meals, medications, transportation, bathing and the small tasks that make independent life possible. Not a hospital bed. Not an institution. Just help. Her daughter called agency after agency. Some had no staff. Some did not serve her area. Some had waiting lists. Some cost more than the family could afford. Winter made everything harder. Ice on the steps became a danger. A short drive became a risk. A simple appointment required planning, luck and someone else’s time.
Eventually Linda fell. Then she fell again. Then she landed in the emergency department, confused, frightened and far from the life she had worked to preserve.
When we talk about long-term care, workforce shortages, Maine’s aging population, home health funding and the cost of staying in one’s own house, we are talking about Linda. We are asking whether aging in place is real or just a phrase in a campaign brochure.
So when candidates ask for our votes, we should ask better questions.
How will you reduce the prior authorization burden that delays care and burns out clinicians? How will you protect rural access so a Maine ZIP code does not decide whether help is nearby? How will you build a serious workforce plan for nurses, physicians, therapists, direct care workers, pharmacists, social workers, emergency medical workers and mental health clinicians?
How will you keep rural hospitals open without pretending money is unlimited? How will you make primary care, psychiatric care, substance use treatment and home care easier to find? How will you reduce costs without simply shifting pain from insurers to hospitals, from hospitals to clinicians, and from patients to families?
We should also listen for what is missing.
If a candidate talks about taxes but never mentions the cost of illness, something is missing. If a candidate talks about freedom but ignores whether people are free to see a doctor they can afford, something is missing. If a candidate talks about compassion but cannot explain how to pay for care, something is missing. If a candidate talks about efficiency but never acknowledges human suffering, something is missing.
A slogan fits on a sign. Governing shows up at midnight in an emergency department, when a family has driven an hour through snow because the nearest service is gone. Governing shows up when a hospital board must decide whether to cut obstetrics, psychiatry, primary care or home health. Governing shows up when a nursing home cannot find staff, when a patient waits months for counseling, when a doctor argues with an insurance company instead of seeing the next patient and when a working parent skips care because the deductible is higher than the rent.
This Election Day, we should be kind to candidates but demanding of them. We can thank them for running and still ask hard questions. We can respect their character and still examine their plans.
That is not cynicism. That is citizenship.
The best candidates should welcome serious questions. They should be willing to sit with patients, nurses, doctors, hospital leaders, home health aides, pharmacists, emergency medical workers, family caregivers and people who have been harmed by a system that too often feels designed by people who never have to use it.
Maine is a small state with a big heart. We know how to show up for one another. We bring casseroles, shovel driveways, raise money after fires and sit with neighbors in grief. We understand community because we still live close enough to feel one another’s burdens.
Our politics should rise to that same standard.