Jeff Pierce is a former Maine state representative, contractor and real estate developer.

In Maine, we tend to value straight talk. Whether you’re out on the water before sunrise, running a small business or just trying to keep up with bills at the kitchen table, you don’t have much patience for systems that aren’t clear or don’t add up.

That’s how a lot of Mainers feel about healthcare right now.

Costs keep going up. But getting a straight answer on why or where all that money is going isn’t always so simple. And that’s really the point. If we’re serious about fixing healthcare, transparency has to come first, not last, and it can’t be an afterthought.

There are a couple issues in Washington getting attention lately that really bring this home: the growth of the federal 340B drug pricing program and increasing frustration, understandably, with health insurance companies. Different topics, sure. But they point to the same underlying problem: patients are too often left guessing.

The 340B program started with a pretty straightforward goal: help ensure low-income and rural patients have access to affordable medicines. That still matters, especially in a state like ours, where access isn’t something Mainers can take for granted.

But like a lot of things in healthcare, the program hasn’t stayed small.

A 2025 report from the Congressional Budget Office, the first major review of the program in years, found that spending on drugs purchased through 340B grew from $6.6 billion in 2010 to $43.9 billion in 2021, a pace that’s much faster than overall drug spending. The report also points to hospital expansion and the growth of affiliated outpatient clinics as major drivers of that increase.

Now, most people aren’t concerned by program growth alone.

The bigger question, and the one that’s considerably harder to answer, is whether patients are seeing the benefit of the program. Are those savings making prescriptions more affordable? Are they helping people access care sooner, or more easily?

Right now, it’s tough to say. There’s no consistent, easy-to-understand way for patients (or frankly, policymakers) to see how 340B savings are used or how much is passed along at the pharmacy counter. And when programs aren’t transparent, they’re hard to trust.

At the same time, people across Maine are dealing with something a lot more immediate: the rising cost of health insurance.

Polling of Maine voters earlier this year found that 73% say premiums, deductibles and coverage denials are their biggest healthcare pain points. That shouldn’t surprise anyone who’s had to navigate the system lately. You can have insurance, follow the rules, do everything right — and still end up with bills that don’t quite make sense. Or coverage decisions that feel arbitrary. Or both.

If you step back for a second, these issues really aren’t separate. Whether it’s how 340B dollars are used or how insurance companies make decisions, the common thread is pretty simple: people don’t have a clear view of how the system actually works. And that’s a real problem.

To be clear, this isn’t about assigning blame. Maine’s hospitals are important, especially in rural parts of the state. Insurance coverage matters too. Nobody is suggesting otherwise.

But trust in the system depends on people being able to understand it. And right now, while healthcare costs continue to rise, too much of it feels out of view. There are practical ways to improve that.

For 340B, that starts with clearer reporting — plain information about how savings are generated and, just as importantly, how much of that is reaching patients directly. Not complicated filings that only experts can parse, but something people can actually follow, and information policymakers can use to inform thoughtful reforms.

For insurers, it means more transparency around pricing, coverage decisions and what’s really driving premium increases. People shouldn’t have to guess what something will cost until the bill shows up, or struggle to understand why a treatment may not be covered.

These aren’t big, sweeping ideas. They’re pretty basic, actually.

In a place like Maine, where people rely on common sense and a fair deal, it shouldn’t be too much to expect a healthcare system that’s at least understandable, or maybe even predictable, once in a while.

Fixing healthcare isn’t going to happen overnight; everyone knows that. But bringing more transparency into the system is a realistic place to start. And honestly, it’s overdue. At the end of the day, patients deserve a system that is clear, straightforward and built with them in mind.

Outrage and empathy are palpable here, as residents want to know why Durán Guerrero was shot while driving near his apartment. Senator Angus King of Maine was told by Markwayne Mullin, the US Homeland Security secretary, that Durán Guerrero had not been the intended target of an arrest warrant and deportation order, according to King’s office.

King, an independent, said Mullin initially told him that Durán Guerrero had “weaponized” his car while agents tried to stop him about 7 a.m. Monday.

A witness to the shooting said Durán Guerrero was streaked with blood as officials dragged him out of his white sedan and onto the street.

For a hardscrabble, blue-collar city that was built by immigrants — French-Canadians, Irish, Albanian Muslims, and newer arrivals from Africa and Latin America — any sense of powerlessness is tough to stomach.

“This place was worthy, it was strong, and it was a true community during its hard times,” said state Representative Marc Malon, who represents part of Biddeford. “This used to be a depressed place, and that has changed. I haven’t even begun to reconcile how angry I am.”

Many of Biddeford’s 22,000 residents, Malon said, did not fully appreciate the fear that permeated immigrant communities in Portland and Lewiston early this year, when an ICE surge swept up more than 100 people in what the agency called Operation Catch of the Day.

Now, Durán Guerrero’s killing has brought the immigration crackdown, tragically and directly, to the streets of this coastal city, once called Trashtown USA by its detractors. Until a decade ago, more than 100 trucks rumbled down Main Street every day to deliver load after load of pungent waste to a large trash incinerator, residents said.

“That smell of garbage, you could smell it from Scarborough,” said Holly Culloton, who cofounded the Biddeford chapter of Showing Up for Racial Justice.

Where once there were vacancies up and down Main Street, Culloton said, now there are small businesses that inject vitality to the once-beleaguered city, although rents are rising and gentrification is a concern.

Old mills have been converted into mixed-use developments. The University of New England is here, and industrial parks have sprouted. But Durán Guerrero’s killing, Culloton said, has scarred the community like the strike of a lightning bolt.

“To have it hit home has been really tough,” said Culloton, part of a team that responds to ICE sightings by driving to the scene, asking agents for warrants, photographing their vehicles, and seeking explanations on the spot.

“They’re creating an element of danger. This is not normal, nor do we want it to become normal,” Culloton said, adding that ICE encounters are becoming more frequent in the city.

“A friend of mine saw ICE agents surround a car at night with guns in their hands. And this is Biddeford, Maine!” Culloton said. “We’re all living on edge.”

A local advocacy group is helping raise funds for Durán Guerrero’s partner, Martha Karolina Rojas Alvarez, and their 3-year-old daughter, Dulce, so they can move from their apartment, which overlooks the street corner where Durán Guerrero was killed.

For them, Biddeford had once been a happy place — where Durán Guerrero would take Dulce to the park every afternoon.

“My daughter asks for Papá, and I don’t have the strength to tell her that Papá isn’t coming,” Rojas Alvarez said Thursday as she shared an emotional statement she had prepared with reporters. “That she can’t hug him anymore, or tell him, ‘Papi, I love you.’ ”

On Wednesday, Governor Janet Mills, a Democrat and fierce critic of the Trump administration, was heckled while visiting the shooting scene. “You ignored us!” Biddeford resident Kelsey Cummings screamed at the governor.

Cummings said later that political leaders had not done enough to curb ICE, although state and local officials, such as Malon, have limited power to influence the federal agency’s agenda. Those officials are calling for a robust investigation of the shooting.

“I don’t have much trust in the federal government right now,” Malon said. “I don’t think ‘lying’ is too strong a word to use in this circumstance.”

In a separate encounter in June, Brandy Rogers of Biddeford said she was stopped by ICE agents in an unmarked vehicle after she had volunteered to drive a neighbor, whom Rogers said is in the country legally, from district court here.

ICE agents pounded on the car’s doors and threatened to shatter its windows if Rogers did not unlock the vehicle, she said.

“I initially refused, shook my head no, but they weren’t having any of it and just kept knocking on the door,” Rogers recalled.

Eventually, Rogers unlocked the car and her neighbor, whom she did not identify, was taken into custody. She was held for three weeks before being released, Rogers said.

LaFountain, the mayor, recalled that Biddeford residents had stood against the Ku Klux Klan more than a century ago, in 1924, when Klansmen paraded in neighboring Saco and planned to cross the bridge into Biddeford.

But Biddeford’s residents, many of them Franco-Americans and Irish immigrants, banded together to block the Klan from entering their city, LaFountain said.

“In essence, they were doing something similar,” LaFountain said of the many people who have gathered in remembrance and protest after Durán Guerrero’s death. “They were standing up for immigrants in our community and across the nation.”

Since Monday, hundreds of people have come to the shooting scene at Hill and Pool streets, where a memorial has blossomed from just a few flowers to a growing array of bouquets, balloons, American flags, candles, and notes to Durán Guerrero and the community.

“We are not criminals,” one person had written in Spanish in a message left there. “We are fathers, brothers, sons, friends, workers.”

A handwritten note in English recalled seeing Durán Guerrero often when the victim worked for DoorDash. “I wish I had asked about your daughter,” the note said.

Tarlicia Aldrich brought her grandson, 8-year-old De’Marcus, who had asked to leave pictures of Bluey, a cartoon character. Durán Guerrero’s 3-year-old daughter had been seen in Bluey pajamas the morning he was killed.

“I want love in my town,” adults helped De’Marcus write on one of the drawings.

Karen Monzon, 21, said she had heard the shots that killed Durán Guerrero. “You feel the injustice. We are not here to be delinquents,” she said in Spanish.

Monzon, who is from Nicaragua and has been living in the United States for two years, works at a Mexican restaurant in Biddeford and said she often saw Durán Guerrero picking up food deliveries there. She also would see him leaving his apartment in the morning.

Monzon said that the positivity she has seen since the shooting outweighs the racism she has encountered. However, she also has noticed drivers yelling support for ICE as they pass the memorial, thrusting their middle fingers in the air.

“The majority are really good people,” Monzon said. “It’s a small group of people who don’t want us here.”

On Wednesday evening, more than 100 people gathered for a vigil at the Unitarian Universalist Church of Saco & Biddeford, where the pews were packed and donations collected for Durán Guerrero’s family.

Religious leaders talked about “welcoming the stranger,” immigrants, and others.

The ripple effect of Monday’s shooting is expected to linger in Biddeford, residents said, just as the memory of the town’s opposition to the Klan has for more than a century.

“We didn’t ask for this to happen,” Malon said. “We will persevere through this together, but we will carry this together for a long time.”

Brian MacQuarrie can be reached at brian.macquarrie@globe.com. Giulia McDonnell Nieto del Rio can be reached at giulia.mcdnr@globe.com. Follow her @giuliamcdnr.

Leyland Streiff is the principal officer of the Protect Girls’ Sports in Maine ballot committee and leader of the Maine Girl Dads, a coalition of fathers whose mission is to restore single-sex competitive sports and private spaces in schools.

We — the Maine Girl Dads, a nonpartisan coalition of 8,000-plus dads united by a mission to protect the sex-based rights of our daughters — believe that Graham Platner has created a significant opportunity for the Democratic Party. Will any candidate take it?

It’s an opportunity to challenge establishment thinking, to reclaim common sense and to reassure females of all ages that their personal boundaries — and their sex-based rights — actually matter (and aren’t just a talking point on the campaign trail).

This is an opportunity to listen to the dozens of women and girls who have come forward to say the current system is broken. That any policies prioritizing gender identity over biological sex are inequitable. That they are sexist, regressive and an affront to their federal civil rights (specifically Title IX, which was a civil right hard-won by women 54 years ago). Rights that the U.S. Supreme Court just affirmed 9-0 are sex-based rights as it relates to competitive sport.

This is an opportunity to believe the young girls and women who have risked everything to courageously come forward and testify on April 14 in Augusta, detailing how current school and Maine Human Rights Act policies have resulted in exposure to voyeurism, masturbation, violence and mental trauma from males in their private spaces and on their sports podiums in our public schools. This should shock and shame us all and spur our leaders into action.

This is an opportunity to restore equality, inclusivity and progressive thinking in school and in sport, as everyone has a sex. Sex is not gender, and there is no right or wrong way to be a male or female (dress, feel, present, identify however you want). Sex is big enough for everyone. It always has been, and always will be. It’s the common, innate and immutable trait that every human shares. Recognizing biological fact doesn’t mean disrespecting personal identity.

This is an opportunity to restore and rebuild the growing fragmentation of the Democratic Party, driven by a voting base that does not carry the radical views of the elected elite. A voting base that increasingly wants progress, not regress, of sex-based rights. A voting base of girls and women that simply want single-sex private spaces and sports (both in our schools and in our jails). And a rapidly growing base of fathers that are no longer willing to watch the political establishment strip away their daughters’ civil rights and dignity for campaign funding.

This is an opportunity to end the sex-based discrimination that happens every day in Maine’s schools, and even in our jails. If a female wants a female-only space or sport (or jail cell), they are owed that legally and morally. We should listen to these girls and women. Believe them. Stop gaslighting them (as so many of our “progressive” institutions like the Maine Women’s Lobby chooses to do). We should honor them. Encourage them. Respect them. Protect them. Seek their consent. Not force them to undress or compete next to a male after they’ve told us they don’t want that.

This is an opportunity to stand up for the sex-based rights of all kids and — in doing so — stand out from the other candidates who will surely continue touting the regressive idea that females are undeserving of private spaces or competitive sports free of males.

Democrat Mainers want a hero. Platner just created an opportunity. Will anyone take it?

Which candidate will step up and meet the moment? Who will believe women and girls? Who will respect their personal boundaries and protect their sex-based rights? Who will stand against the sex-based discrimination that’s currently aimed at our state’s most vulnerable population: our schoolchildren?

We’re rooting for common sense. We’re rooting for candidates of all parties to stand up for every child’s right to single-sex sports and private spaces in our public schools.

We hope they all stand with us and stand with our girls.