Health insurance executives are sometimes painted as corporate fat cats getting rich on the pain of consumers. Profits are clenched in one fist, with the other hand extended for yet another payout.

The stereotypes are being reinforced with Anthem Blue Cross and Blue Shield’s request for an eye-opening 20 percent premium hike on its individual insurance policy, HealthChoice. The request has dropped like an anvil onto consumers: heavy, hurtful and entirely unwelcome.

On one side is Anthem, which says HealthChoice lost $3 million in 2005, will lose more this year, and will continue to lose millions despite the proposed 20 percent hike.

Mark Ishkanian, the company’s spokesman in Maine, said critics are avowed to disavow Anthem’s unhappy reality. “There is a refusal to acknowledge that the cost of paying medical claims has skyrocketed,” he said.

And Anthem executives don’t have chauffeured limousines or paid country-club memberships. Executive compensation “is literally pennies on any policy,” Ishkanian added.

“How much is really necessary?” asks critics like John Henderson, an Auburn man and member of the Maine People’s Alliance, representing an opposite view. This week, he decried Anthem during a press conference in Augusta. “This is the sixth year in a row they’ve asked for a double-digit increase.”

In the middle is the state, which has health insurance woes of its own. Ishkanian said Anthem’s administration costs are stable against increased use of its services. “We’re a lean operation,” he said, and if one thinks administering health care is easy, look to the state Medicaid billing debacle for proof.

Like this debate, Maine’s insurance landscape is also a study in extremes. One-fifth of the state on Medicaid. An aging population straining services and Medicare. In the middle are the average ratepayers, watching their premiums balloon inside this crippling vice.

Or, as Maine’s insurance commissioner Al Iuppa has repeatedly called the health insurance landscape: stuck in a “death spiral.” Anthem’s request for a rate increase is merely another swirl of the fatal whirlpool.

There is hope, as long those lodged in the spiral – Anthem, consumers and the state – agree to squash the squabbling and make an effort toward increasing competition in Maine’s insurance market.

Anthem may have a virtual monopoly, but says it doesn’t want it. The presence of Anthem as the dominant provider of health insurance in Maine is unsustainable for the company and the public, both of which would continue to merely hemorrhage millions under such an arrangement.

And probably unlike any “monopoly” in history, Ishkanian said Anthem actually invites competition instead of resists it. “The best sign that health care rules are fair and equitable is competition,” Ishkanian said.

If that’s the way Anthem feels, then Maine should take it up on the offer. If spoiling for a fight will stabilize Maine’s health insurance industry, than all parties should work toward starting one.