“Too complicated to understand.”

“There are so many mind-numbing details.”

As a teacher, I sometimes get these reactions when I explain health care policy. Unfortunately, these impressions can lead students to abandon any attempt to understand the issue. To overcome this, I try to quickly cut to the bone of health care policy and reveal what I think is its core problem: the lack of universal coverage.

Maine’s Dirigo Choice is based on a belief in providing universal coverage. Since the program has begun to take effect as of Jan. 1, now seems like an appropriate time to revisit its nucleus.

There is a health care crisis. In 2003, 45 million Americans did not have health insurance and health care spending consumed a record 15.3 percent of the gross domestic product. There are approximately 130,000 working Mainers who lack health insurance.

Dirigo Choice is a state-created health care program designed to make insurance financially possible for the self-employed, small businesses, local governments and individuals. The program is furnished by Anthem and has many different plans.

Defenders of Dirigo believe that when more people have insurance, the cost of health care will go down. For example, citizens will get more regular check-ups and make fewer emergency-room visits. This will lead to preventable illnesses being treated earlier and more effectively. Money that is now being spent on emergency care will be diverted to preventive care. Overall medical spending will go down.

Many small businesses have a difficult time providing health insurance for their employees. Unlike large organizations, they can’t take advantage of the cost-savings that are produced by a large pool of employees. Any plan that they can afford, their employee probably can’t. Any plan their employee can afford, they probably can’t. The choice between profitability and “doing the right thing” by their workers is a structurally produced dilemma. Dirigo is designed to eliminate this false choice.

When people don’t have health insurance, they usually cope with their vulnerability by living in denial or tolerating a repressed anxiety. For example, many young people believe that they will never get seriously ill. When they get sick, or have an accident, denial gets pushed away by reality. Often, they emotionally cope with their situation by embracing the role of the victim. Even if one consciously realizes the liability of being uninsured, the financial consequences of a major illness are too overwhelming for many to think about. This can create a persistent, low-grade anxiety that is never verbalized. All of these dynamics can occur in addition to the medical condition itself.

Critics usually don’t directly say that universal health care is a bad goal for Maine. It’s the method that they have a problem with. Some believe that individuals and markets should control how health care dollars are spent, not government. For example, the Maine Heritage Policy Center believes that citizens can do better by putting their money into a Health Savings Account or even by purchasing cheaper health insurance outside of Maine.

Others believe that Maine simply cannot afford Dirigo now. With a huge state budget deficit, Augusta should be thinking about ways to spend less money, not more. Maine received $53 million in federal money last year that was used for start-up costs for the program. However, that money will not be available in the future. The program is bound to need additional money before the promised cost savings begin to appear.

Moreover, there is talk that the Bush administration wants to “reform” Medicaid. Medicaid is the federal-state program designed to provide health insurance to the disabled and poor. “Reforming” Medicaid might translate into less federal money for Maine, given the need to reduce the record federal budget deficit. If there is less federal money, there may need to be more state money.

Many of these critiques are valid and should be carefully considered when Dirigo gets debated this legislative session. For example, the proper mix of state and federal money and the monthly costs and discount eligibility rules of the various plans are important details that need to be analyzed. However, the core principle of universal coverage should not be forgotten.

What underlying assumption supports this core principle? That health care is a right and not a privilege. It is this premise that gives Dirigo Choice its logic and strength. Supporters should continually refer back to this basic notion for sustenance when the budget battles begin in earnest later this winter. They should also be prepared to honestly talk about what responsibilities go along with that right.

Karl Trautman is the chairperson of the Department of Social Sciences at Central Maine Community College. He was a policy analyst with the Michigan Legislature from 1997 to 2001.

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