Cindy Young of National Nurses United addresses a town hall meeting in Portland, ME.

Before Saiyid Brent stopped in for a free basic health screening in Portland Monday night, his thoughts were on dinner - specifically, comfort food. But that changed after he was examined by a nurse. His prognosis? "Not so well!" he says, with a laugh. "My blood sugar was pretty good, but blood pressure not so great, which is a concern."

Brent came in for the screening because he doesn't have health insurance. And he can't think of a good reason why he doesn't.

"Um - that's a good question. Why don't I have health insurance? I'm working, why don't I have health insurance right now?" he says. "It's expensive. I mean, to get it on my own is expensive - even where I work offers it, but if I go through them, half the check's gone."

Brent doesn't know whether he'll qualify for a subsidy to buy insurance under the Affordable Care Act. And for advocates behind the push for universal health care, that's not even the real issue. They say that while the Affordable Care Act brings some positive change to the U.S. health system, and will increase access and lower costs, it doesn't correct one fundamental flaw: the middle man. Or, in this case, the insurance companies.

"As long as people can profit - as long as the first $5 million they make has to pay their CEO - how can that be cost-effective?" says Michelle Milton, a home care nurse.

Milton says from the day she started nursing school back in the 70s, she was convinced that the U.S. payment system for health care needed to change. Even though she has insurance, Milton says she feels the pain of a high deductible plan, just as many of her patients do. That's why she wants a "Medicare for all" system, funded through taxes, on a sliding income scale.

"There needs to be a level playing field - that's what this country is about," she says. "And that's what this will do, is level the playing field - so that everybody has a shot, and nobody has to worry about the basics. So they can all worry about the wonderful things we can be out there doing, and it's going to benefit eveybody."

Philip Caper of Maine AllCare, a group dedicated to bringing universal care to the state, says the Affordable Care Act further slices and dices the system, spreading benefits unevenly while still leaving an estimated 30 million people without health coverage. He says expanding Medicare is simpler and cuts out administrative costs.

"Most people also don't undertand it's actually cheaper to cover everybody than it is to spend a lot of money deciding who not to cover. Or what to cover, or who their providers are," Caper says. "All of that is very expensive."

The Portland and Bangor health screenings and town hall meetings are designed to inject a dose of energy into a movement for universal health care. Gordon Smith of the Maine Medical Association says physician support for universal care through something like Medicare has grown over the years, but doctors tend to doubt the prospect of it ever happening.

"You know, we've seen how difficult it is to even enact improvements to the existing reform," Smith says. "The ACA was a very conservative piece of legislation based upon improving the current system and leaving in place private health insurance, for instance. And look at how controversial, indeed, even that modest effort has been."

But universal care proponents, like Drew Joy of the Southern Maine Workers Center, say reform can happen starting at the state level.

"And I think that that's really what we're saying: 'Look, this may be the new law nationally, but we as Mainers, we want something better for our folks, and we're going to make that happen here.'"

And Philip Caper of Maine AllCare says the Affordable Care Act actually makes it possible. Because as of 2017, states will be able to apply for a waiver to create their own statewide health plans.

Photo:  Patty Wight