Talk of Universal Health Care Grows

In California, Pennsylvania, Massachusetts and Maine, state leaders said they were spreading the pain to every player, so every critic should stay on board.

"That's always been the biggest challenge in health care reform. There is no pain-free solution," said Drew Altman, president of the Henry J. Kaiser Family Foundation, a Washington-based health group.

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CHANCE OF SUCCESS: The next few months will determine whether enthusiasts like Rendell or Schwarzenegger win the argument.

In Minnesota, GOP Gov. Tim Pawlenty warns that simply focusing on getting everyone insurance ignores deeper problems, even as some leaders of the Legislature's new Democratic majority say this is the year for universal health care.

"Many policymakers around the country are so fixated on more access, they're losing sight of the need to simultaneously focus on cost and quality," Pawlenty said. "Expanding access to a broken system is no solution. ... In the long run, that will be a failure."

He wants universal coverage, he insisted, but warns that government can't end up with the bill. His plan would broaden coverage to more uninsured children and have the state create a marketplace where insurers can provide a more affordable product. It wouldn't mandate that everyone get coverage.

There are even deeper philosophical differences in other parts of the country, particularly more conservative states which have emphasized cutting Medicaid costs rather than expanding coverage.

But the new ideas are even getting an airing there.

In Florida, where the biggest health care change under former Gov. Jeb Bush emphasized cutting costs of Medicaid, the new surgeon general talked enthusiastically of Massachusetts' universal health coverage law _ and new GOP Gov. Charlie Crist said he wouldn't rule out considering something along those lines.

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FLASH IN THE PAN? How the Massachusetts program and high-profile proposals do also will decide the staying power of health care as a political issue. After President Clinton's health care reform attempt failed in the 1990s, the issue went dormant for years.

"Once you pass these programs and start the implementing, it only gets harder," said Maine Gov. John Baldacci, a Democrat. "Because then you're talking about real dollars and real decisions."

Maine hasn't met its ambitious goals, with fewer businesses signing on to the state program. But Baldacci and state leaders are trying to fix the flaws.

"Hopefully," he said, "the chambers of commerce, the unions, the businesses will recognize we need a solution."