As the old joke goes, a camel is just a horse designed by committee.

Same with Dirigo Health.

The health care reform was designed with input from many quarters – businesses, insurers, consumer advocates, politicians, hospitals. Its design combined private insurance with expanded Medicaid eligibility, cost controls and comprehensive statewide health planning

The goal was universal coverage, with a bunch of caveats. The result is a system that must be voluntary, private and competitive, that reduces the number of uninsured and increases access to affordable, comprehensive health insurance but doesn’t raise taxes.

Given those limitations, it’s a wonder Dirigo functions at all.

But function it does. Many of the 7,400 people who are enrolled in the insurance program swear by it. About 2,000 people who lacked insurance before have signed up. The rest have been able to replace high-deductible policies that provided limited benefits with a more comprehensive plan.

One woman told us this story. She owns a small business that employs her, her husband and one other person full time. Before Dirigo, they could afford only a policy with a high deductible. She and her husband were reluctant to seek medical attention even when they needed it. The out-of-pocket expense was prohibitive. Dirigo allowed her to have an MRI, which helped to detect a serious medical condition. Without Dirigo, there would have been no test and the disease would have likely gone undiagnosed.

But Dirigo ain’t cheap and, even though it has been one of the fastest-selling insurance products offered in the state, it hasn’t covered as many uninsured as projected. The state’s spent more than $50 million getting the program off the ground. That’s made it a target, even to some of its original supporters in the Legislature.

To pay for the program, the Dirigo law seeks to capture the savings in the health care system created by the program – called the savings offset payment. After a long process, Maine’s superintendent of insurance determined that Dirigo has saved $43.7 million for hospitals and insurance companies. Under the law, it’s the responsibility of insurance companies to collect those savings, which are then used to fund Dirigo.

Dirigo’s opponents call the savings offset payment a tax on people who purchase insurance outside the system, a claim that makes rhetorical sense to a lot of people, and say they will pass the cost onto consumers outside Dirigo. Gov. Baldacci says, if necessary, he’ll introduce legislation to keep that from happening.

The state Chamber of Commerce, the Maine Association of Health Plans and a third group representing insurance providers for car dealers and bankers are appealing the decision. They say that the savings are significantly less than the $43.7 million or nonexistent.

Without the savings offset payment, there’s no Dirigo.

Mainer’s spend about $8 billion a year on health care. Navigating the maze of where the money goes is difficult. The process used by the superintendent of insurance to calculate savings appears legitimate, and it would be unfair to pass along the payment to consumers.

According to the Kaiser Family Foundation, Maine is the only state in the Northeast – and one of only eight states in the country – that has reversed the growth in its number of uninsured. Between 2000 and 2004, the number of uninsured Mainers dropped from 136,000 to 130,000. Nationally, the number of uninsured has continued to climb. Much of Maine’s progress can be attributed to increased eligibility for Medicaid, which is also part of Dirigo. Dirigo has the potential to further reduce the rolls of the uninsured and continue improvements in the state’s health care system.

Given the choice of a beautiful Arabian or an ornery camel, most people would pick the horse. But for people who find themselves in the desert of no insurance coverage, a camel is a welcome alternative.