STATES TAKE ON NATIONAL HEALTH INSURANCE CRISIS

The list of what's wrong with American health care is sickeningly long and increasingly familiar to millions.

•One in seven Americans, lacking insurance, foregoes needed care or receives treatment that's inadequate and expensive at overcrowded emergency rooms. Most of the cost is passed on to others.

•Those lucky enough to have insurance have seen their premiums double in a decade, while they get less for their money. Co-pays are up, reimbursement rates are down, and some top doctors won't take insurance, making their services available only to wealthy patients.

•Nearly everyone squanders money and time fighting through payment hassles with their insurance companies, and anyone can abruptly be left without insurance at any time, at enormous medical and financial peril.

But now, for the first time since Bill Clinton's health plan collapsed under the weight of its own complexity a dozen years ago, a powerful new move to address those problems appears to be building.

Two Republican governors in Democratic states — California and Massachusetts — have proposed strikingly similar reforms to cover nearly every resident. Roughly, they look like this: Everybody is required to have insurance, much the way car owners in most states are required to have auto insurance now. But they can pick a plan and an insurance carrier that suits them. Prices vary, as does what's provided, but everyone gets at least coverage for some preventive care plus major hospital bills.

Massachusetts' plan, championed by former governor Mitt Romney, who has presidential ambitions, is already in place. In California, where nearly 20% of the population is uninsured, the battle is just beginning. Last week, Gov. Arnold Schwarzenegger proposed covering all 6.5 million of them, including 1 million illegal immigrants. Those who have insurance also would benefit, because they now pay a hidden tax estimated at $1,186 per family to cover unpaid medical bills of the uninsured, according to the New America Foundation, a health policy think tank.

As in Massachusetts, the plan would require most employers to provide coverage or pay additional taxes, which would be used to subsidize their employees and others needing insurance. It also makes tough demands on doctors, hospitals, insurers, taxpayers and employers. Schwarzenegger argues, logically, that cost savings can be achieved only when everyone has coverage so that the healthy join insurance pools along with the chronically ill. Nearly 3 million Californians whose jobs provide coverage turn it down because they think they don't need it.

There's "something for everyone to hate" about both states' plans, as many commentators have noted. Those on the left argue that they don't guarantee affordable premiums and could cause employers to drop coverage; business groups say the plans amount to a new tax on employers that could kill off jobs. But there's no such thing as a health plan that has no downside, which is why reforms are so easily demonized and killed by interests that benefit from the inefficiencies of the current system.

There's a lot to like in the two states' plans:

•Unlike European-style plans, they preserve private insurance, and therefore choice and innovation, with government oversight.

•They spread the cost burden fairly and more efficiently. Everyone is covered; everyone must contribute. Government subsidizes the poor, which is more cost-effective than the way their care is handled now.

How well the plans will work — and whether California's will even be passed — remains to be seen. But the good news is that after a decade of dormancy, attempts are finally being made to fix a system that tens of millions of people recognize is broken.

A national solution would be preferable, but having states serve as laboratories for experiments will let us see which ideas work and which ones should be abandoned.

Perhaps Washington will take notice and at long last act.

(c) USA TODAY, 2007