Oregon's Wyden leads the way on health-care reform

The health-care issue is back and about to beat its hairy chest in the coming presidential campaign. A new CNN polls shows 43 percent of adults rating health care as "extremely important."

But Oregon Sen. Ron Wyden doesn't want to wait until 2008. The Democrat's Healthy Americans Act is the first serious proposal for universal coverage in 13 years. Some business leaders and unions have blessed it, as has influential Republican Sen. Bob Bennett of Utah.

"All the popular betting is of course you can't fix health care before the presidential election," Wyden told me, "and this is a time to hear what Rudy thinks or McCain thinks or what Hillary thinks or what Barack thinks. The American people can't wait for another presidential election."

Wyden is right about that. And he fears that some awful thing could happen right after the vote that pushes the issue back in its cage.

Here's how the plan would work: Each person would pick a private health plan from a list offered by a regional purchasing group. (People in Medicare or the military would not participate.) The quality of coverage would have to match that available to federal employees.

Americans would pay their premiums through an add-on to their taxes. The poorest of the poor would pay nothing, and low-income Americans would receive subsidies.

The Lewin Group, a respected health-care consultancy, thinks the plan could reduce annual health-care spending by $4.5 billion in its first year, even after expanding coverage to the 46 million uninsured. The savings would come from lower administration costs and more price competition among insurers.

The proposal's greatest triumph would be ending our reliance on employment-based coverage. Corporate health benefits, which are tax-free for workers and deductible for employers, favor the wealthiest and trap many Americans in jobs they'd love to leave.

And what about workers who've been getting health coverage as part of their compensation? In the first two years, their employers would have to give them cash for the cost of the benefit no longer provided. After that, they would contribute some percentage toward the employees' premiums.

Wyden's vision has its skeptics. Time and again, private interests have demonstrated their talent for buying off Congress, at great expense to both consumers and taxpayers. And many are loath to further empower the executives who have been squeezing patients and doctors while pocketing outlandish fortunes.

Single-payer advocate Dr. Don McCanne doubts that the plan can produce the promised savings. The companies in the federal employees' plan have their own administrative and marketing costs, says McCanne, a health policy analyst with Physicians for a National Health Plan. They also play games to shift risks. "All that is expensive," he adds, "and none of it goes away under this model."

On the contrary, Wyden argues, his plan would put insurers in a very different ballgame — so much so that he expects the industry to resist several parts of it. There would be no more cherry-picking of healthy customers. There would be community rating — that is, insurers would have to charge everyone in the area the same rate after taking family size into account.

Wyden says he told the insurers, "You won't be put out of business as folks in single-payer want, but your industry is going to change dramatically if my law passes."

Back home in Oregon, people often ask him: Why not just do single payer? Wyden responds that five years ago, Oregon's voters were given that option and turned it down by a ratio of 3-1.

Wyden's approach to universal coverage could be politically viable, and the public is hungry for a deal. This deserves a hard look.

Providence Journal columnist Froma Harrop's column appears regularly on editorial pages of The Times. Her e-mail address is fharrop@projo.com