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You haven't heard much talk in Washington about a big fix for health care since Hillary Clinton's effort crashed in 1994 and almost took her husband's presidency with it. But the problem of rising costs and diminishing coverage hasn't gone away; it has got worse, to the point where some states now devote more of their budget to Medicaid than to education. Health fears always rank near the top of voter concerns.

So reform is back in a big way--only this time, the push is coming from the states. Massachusetts passed a program last year requiring nearly all its citizens to carry health coverage. Maine and Vermont have moved to guarantee everyone health care as well. And now comes the boldest move, from California, where Republican Governor Arnold Schwarzenegger aims to extend coverage to almost all the 6.5 million uninsured residents of the nation's largest state.

Some elements of Schwarzenegger's plan are strikingly similar to the failed Clinton plan--most notably, a requirement that employers provide coverage for their workers. California's mandatory-coverage rule would apply to businesses with 10 or more employees and give them an option to put 4% of their payroll into a state fund instead.

The parallels have not been lost on Senator Clinton. "There are only a very few ways of getting there," she told TIME in an interview. "That's what everyone is finally recognizing." Schwarzenegger also borrows from the Massachusetts plan a requirement that individuals carry health insurance--the way car owners must have auto insurance--with subsidies for the state's 1.2 million poor. He would pay for part of it with new taxes on hospitals and doctors and offer coverage to illegal immigrants--all controversial ideas.

Since Clinton's plan died, the Federal Government has attacked health care only at the margins--by covering more children, for instance, and narrowing the parameters by which insurance companies can deny coverage. Oregon Senator Ron Wyden, a Democrat, proposed a universal-health-care bill in December, but it has got virtually no help from the Democratic leadership. In the last election, House Democrats made only narrow promises on health-care coverage in their "Six for '06" agenda, including Medicare prescription-drug reform and the funding of stem-cell research.

But some believe the political climate around the issue is changing as the problem gets worse. "It is harder for anyone to claim that the market will correct itself if only government would stay away," says Ira Magaziner, the policy guru behind the Clinton plan.

Clinton says lawmakers will be watching closely to see how California and other states fare in trying to solve a national problem that Washington has abandoned. "We'll learn a lot about what works and doesn't work," she says. "We're certainly going to see the political hurdles … There isn't anybody in the country who knows more than I do how difficult this is."

At least one Republican Governor will soon find out.

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By Karen Tumulty

STATES' HEALTH INSURANCE PLANS WON'T CURB COSTS

New plans in Massachusetts and California to reduce the cost of health insurance will do the opposite ("States take on national health insurance crisis," Our view, Health care reform debate, Tuesday).

When politicians "mandate" something, they cannot resist meddling with and overregulating the laws we will be forced to obey. Requiring all insurance policies in California to pay for "wellness" care, such as everyone's gym memberships, will not reduce insurance premiums. A new tax on physicians and hospitals will not curb the cost of health care.

These proposals are just another case of the growth of government making things worse in the name of making them better.

Richard E. Ralston, executive director, Americans for Free Choice in Medicine, Newport Beach, Calif.

Taxpayers will foot bill

USA TODAY's article "Schwarzenegger proposes health plan" outlines another liberal, socialist program in California that requires those who work and pay taxes, the middle class, to support those who don't (News, Jan. 9).

Ostensibly, the program will operate with, as USA TODAY says, "the state's doctors, hospitals, insurers, taxpayers and employers all helping pay for it" -- as though each group had respective pockets. No doubt, costs will be passed down to the only group shouldering the burden -- taxpayers.

The article observes that the plan may have "ripple effects" across the nation. In other words, California Gov. Arnold Schwarzenegger, seen as a charismatic, hard-working moderate, is the one pushing just another national social boondoggle. This way, it doesn't have to be proposed by House Speaker Nancy Pelosi, D-Calif., or Senate Majority Leader Harry Reid, D-Nev., viewed by many as "tax-and-spend liberals."

Schwarzenegger said, "We can make health care more affordable, accessible and equitable for everyone." Really? Does that include all illegal aliens?

He also says people may be rewarded for living healthy lifestyles. Why isn't this already the case? Why must they accept reforms before they see these rewards?

Yet another twist: Insurers won't be able to turn away applicants because of health problems. Apparently, people who have made poor choices that resulted in chronic, long-term diseases would be supported by more responsible insured people.

Great. Just what we need: another program where those who work, pay taxes and take care of themselves pay for those who don't.

Timothy Brown

Cincinnati

(c) USA TODAY, 2007