It’s understandable that some people might get carried away on Election Night. Corks are popping, crowds are cheering and, for a brief moment, anything seems possible.

It was probably in that spirit that Tarren Bragdon, the still-youthful CEO of the Maine Heritage Policy Center, proclaimed to a New York Times reporter that as soon as Paul LePage took office, Gov. John Baldacci’s Dirigo Health program would be “Dirigone.”

Bragdon isn’t subtle about his animus against Dirigo. Just after the bill had been enacted by the Legislature with significant bipartisan support, he was telling conferees that it had “failed.” But while his credibility on the subject might be questioned, it’s his role as one of the three co-chairs of LePage’s transition team that focused attention on the remark.

Asked for the Gov.-elect’s response, spokesman Dan Demeritt said that Dirigo would be “gone” only when the new administration comes up with a suitable replacement.

And that is the reality facing Republicans both in Maine and across the nation. GOP gains in Congress were attended by numerous pledges to repeal the reform bill Democrats finally passed last year at President Obama’s urging, after many months of trying.

Republican governors have questioned whether it might make sense to abandon Medicaid. That’s the joint federal-state program that not only provides health care for low-income families with children, but supports nursing home care provided for the elderly and disabled.

The common theme in all these ventures is that health care costs too much, and is outpacing state and federal efforts to provide it. On that point there can be no argument. American health care may or may not be the best in the world, but it is incontestably the most expensive, nearly 50 percent higher than the universal systems common to Europe, Japan, Canada and our other economic competitors.

Yet it can be questioned whether dumping people off government programs represents any kind of solution.

The reaction to the federal reform bill is instructive. After it passed, the country appeared almost evenly divided about its virtues. This is not surprising. Major changes in health care are always controversial.

Medicare, the one government health-care program no one is suggesting be repealed, was denounced by the American Medical Association as “socialized medicine” before its passage in 1965.

It’s a measure of how political tides reverse that it was Republicans who characterized the Obama reform bill’s provisions, which restrain the future growth of Medicare costs, as “cuts” that would damage health care for seniors.

A similar process may have started again. Though Nov. 2 exit polls still showed the public divided, two-thirds of those who disagreed with the measure said it didn’t go far enough. A substantial portion of the electorate believes the private insurance system isn’t necessary, and that we would do better with a national single-payer system with government as the insurer. The experience of all our global competitors shows there’s much to be said for this belief.

As various provisions of the law go into effect, its popularity is rising. People are discovering how little the states regulate private insurance, and how much of their premiums go to profit and overhead. In some states, as little as 50 percent of premiums must be paid out in claims. A new national regulation makes that 85 percent. Voters overwhelmingly support provisions that insurers not be allowed to deny coverage based on “pre-existing conditions,” and prohibit canceling policies on technical, if not whimsical grounds.

The part people don’t like is the “individual mandate,” a requirement that people buy insurance or pay a penalty if they’re not covered by an employer-based or government program. If there were a single-payer system, of course, there’d be no need for such a mandate.

These are some of the obstacles the LePage planners face in replacing Dirigo Health. The national strategy, which depends on state cooperation, gradually covers everyone through three methods. The first is an expansion of Medicaid to cover more low-income families and adults. The second is an overhaul of Medicare to deal with its soaring costs and its unimpressive record in such areas as end-of-life care. And the third is to provide subsidies for middle-income workers who must obtain insurance on their own or through a small business.

It’s an adaptation rather than revolutionary change, and, in that respect, resembles Dirigo, which uses subsidies for small business and individuals plus reforms to contain costs and promote preventive and primary care.

If the private sector is to do all this more efficiently and at a lower cost, Republicans must explain how it will work.

Douglas Rooks is a former daily and weekly newspaper editor who has covered the State House for 25 years. He can be reached at [email protected].