FREEPORT – A state study commission has ample time before a March deadline to create a plan for a state-run universal insurance program, two national experts said Thursday. But they differed on whether it should.

The two experts, speaking at the request of the Maine Hospital Association, took starkly different positions on what the future health insurance landscape should look like. They argued in front of more than 200 hospital administrators, legislators, state officials and others.

Dr. David Himmelstein of Harvard Medical School argued for a Canadian-style system that would have better funding. Robert E. Moffit of The Heritage Foundation said the employer-based insurance system isn’t working and suggested overhauls to the tax system to enhance insurance options.

The debate couldn’t be more timely. Maine’s health care system is in trouble, and there has been a growing call for drastic overhaul of a system many residents say is increasingly unaffordable. Next month Portland voters will consider whether the city should develop a universal insurance system.

At the state level, a universal health bill became a hotly debated topic last legislative session, to the surprise of many veteran observers. Though the bill was long considered a drastic remedy, lawmakers indicated they were willing to move ahead. Ultimately, they agreed with the governor to create a 19-member study commission, which will report back with recommendations by March.

Thursday night, both speakers said a single-payer plan could indeed be quickly approved and enacted because models exist abroad in places such as Canada and the United Kingdom. Even in the United States there are models such as Medicare and the Veterans Affairs system, they said.

Himmelstein, a Harvard professor and co-founder of Physicians for a National Health Program, said Maine is uniquely positioned to become the first state in the nation where everyone could have coverage. With government already footing much of the country’s medical bills through government programs, paying for the rest would eliminate the profits taken out of the system by insurers while also shaving administrative costs. Right now, he said, the U.S. system is awash in administrators trying to oversee every individual’s care.

Himmelstein said one 900-bed hospital in Canada had just three people and a desktop computer to handle billing for Americans who came in needing care. A 900-bed hospital in the United States had more than 350 workers and expensive computer systems.

“If you’re willing to spend what we now spend you can have a superb system – far better than Canada has,” Himmelstein said.

Moffit criticized Himmelstein’s analysis and sarcastically suggested Maine should continue to develop a universal, single-payer system.

“You are charged with turning your health care system into a wholly owned subsidiary of your state government,” he said.

He said a state-run system would necessarily be ruled by political decisions that would limit patients’ doctor and care choices. “You will surrender a huge amount of decision-making,” he said.

Moffit said he does believe the health care marketplace is broken. To fix it, focus should be put on the fundamental problems of the system, he said. Unlike auto insurance, where individuals foot oil-change and other routine bills, health insurance pays for many routine checkups, he said.

He said that should be changed and tax codes should be changed to encourage more than just employer-based insurance plans.

Asked about the challenges to Maine in adopting a universal system, Himmelstein said waivers would be needed from the federal government related to Medicare and Medicaid. He said the state would also need to set up a clear residency requirement to address the problems of people coming to Maine for the system.

Moffit said that while it wouldn’t be difficult to enact the systems for a single-payer system, there are many questions to be addressed.

Will Maine-based employees of out-of-state companies have to give up insurance plans? Will everyone be treated the same? Will people denied care be able to sue over any mishaps? Will federal employees have to give up their insurance?

Himmelstein minimized the role of such questions. “What people care about is that they can get the care they need,” he said.