MANCHESTER -- The United States needs to make a serious investment in health care -- and fast, the head of the state agency that regulates health insurance said Thursday.

"The health care crisis is like a disease killing the American middle class," said Mila Kofman, superintendent of the Bureau of Insurance.

Kofman and more than 20 other Mainers with a vested interest in the health care system shared their ideas with U.S. Rep. Chellie Pingree, D-1st District, for how Congress and President Barack Obama should reform the nation's health care system.

Kofman said a public option, as has been proposed by Obama and supported by Pingree, would bring "competition based on quality and efficiency."

"I am fully committed to improving the private health insurance market," Kofman said. "That is why I support a public health plan option."

Obama's public option would allow those who have insurance to keep it, and would create a government-run program for others.

Pingree said costs would go down if everyone had health insurance.

"I happen to be in the camp of great concern that, if we don't have a public option, we won't be able to reform the system," Pingree said.

Pingree's listening session at the Maine Medical Association headquarters in Manchester came one day after Obama praised U.S. Sen. Olympia Snowe, R-Maine, for her willingness to work toward consensus on a national plan.

Obama also said Congress must avoid delays that "prevented change in the past."

Those who spoke to Pingree on Thursday talked about the need for a strong network of primary care physicians and placed an emphasis on their areas of specialty.

Katherine Pelletreau, director of the Maine Association of Health Plans, which represents the major insurance carriers in the state, said the current system is out of balance because those already on public programs "are not paying their fair share."

"Make sure you don't exacerbate the cost shift," she said.

Dr. Jonathan Shenkin, a local dentist who is president of the Maine Dental Association, said dental care is a vital but often overlooked part of the health system.

He said that while 47 million people nationally don't have health insurance, 130 million Americans don't have dental coverage. Also, he said there's concern that, if benefits are taxed, companies would drop dental coverage for employees as a way to save money.

"Oral health is not on the radar," he said.

Groups represented at the discussion included the American Lung Association of Maine, Maine Osteopathic Association, Physicians for Social Responsibility and the National Federation of Independent Business.

For small-business owners, they keys are reducing the cost and giving business owners options when it comes time to purchase coverage, said David Clough, head of the National Federation of Independent Business Maine.

Three insurance companies write 95 percent of the policies in Maine, he said.

"That's not much choice," Clough said. "That's not much competition."

The fear of not having health insurance can hurt the entrepreneurial spirit, said Paul Santomenna, who spoke on behalf of Physicians for Social Responsibility. That's been one of the failures of the current employer-based system, he said.

"One of the blocks to entrepreneurialism is you have to put yourself out on a limb, and one of the biggest risks is putting it all out there without health insurance," he said.

Dr. Jo Linder, chairwoman of the Maine Medical Association Executive Committee, said change must happen this year.

Her group, which represents more than 3,000 physicians, medical students and residents, believes that all Americans should be required to buy health insurance.

"Research evidence shows that, even if we provide public subsidies to those persons who cannot afford insurance, many persons will not choose to purchase insurance," she said. "We believe it is reasonable therefore to require persons to purchase insurance, with appropriately provided public subsidies."

Susan Cover -- 620-7015

scover@centralmaine.com