PORTLAND – Three of four candidates for governor sparred over their strikingly different plans to address Maine’s health care woes at a forum Monday. At times, Republican Peter Cianchette sat quietly as Green Independent Party candidate Jonathan Carter and Democrat John Baldacci threw barbs at each other’s proposals.

Carter attacked Baldacci’s universal access plan, which would feature a new nonprofit health insurer for Maine on top of existing insurance plans. He said it was a rehash of ideas that have failed before and would fail again. And he told Baldacci, “If you support the goals of a single-payer system, you ought to support a single-payer system.”

Baldacci labeled Carter’s plan “pie in the sky.” He said it would take as long as 10 years to implement because it needs federal waivers and other approvals.

Cianchette said Baldacci and Carter were advocating plans that would expand the role of government in health care. The Republican envisions reforms leading to a free-market fix. He also said no one could fix health care without first addressing the state’s budget shortfall and ailing economy, issues that have been a priority of his throughout the campaign.

The only candidate not present at the Maine Public Health Association’s public forum, which drew about 100 people, was independent John Michael.

After the 11/2-hour debate, Megan Hannan, president of MPHA, said she was pleased that public health is a priority for candidates, and that, despite the different plans, each wants to improve the system.

Baldacci said that his approach calls for creating a new entity using the buying power of state employees and state retirees and others who want to join. The idea is that small businesses and employees could buy more affordable insurance under the system.

There would be a state health plan to assess the need for expensive medical services and technology. This would strengthen the “certificate of need process” the state now uses to decide who can add what services.

Carter said his idea of a single-payer system paid for by government is neither radical nor extreme, because it is already in place in most industrialized countries.

“The only reason we don’t have it is money and politics,” he said.

He said such a system would eliminate the profits taken by insurance companies, and it would trim administrative costs. Carter estimated that the state could save $1 billion a year from the $5 billion paid in the state on health care.

“The reforms I believe are most appropriate are going to be marketplace reforms,” said Cianchette.

Cianchette said he would do an entire assessment of the needs in the state. He said he also favors giving more health care information to consumers so they can make informed choices.

A variety of other issues was raised during the forum. All three candidates said they were in favor of increased preparedness for bioterrorism, although Carter said that affordable housing, energy, health care and food were also forms of security.

To a question from moderator Mal Leary, all three candidates agreed they would not support further diversion of tobacco settlement money from prevention programs.

In response to Juliana L’Heureux, a home health care and hospice representative, all three candidates said they would give health care providers a voice in policy deliberations. L’Heureux complained that some bureaucrats don’t want to listen to home health workers. She said there are term limits on politicians, but none on bureaucrats.

Whoever wins, “we’re going to hold them [to it],” L’Heureux said.