Let's Try a Dose. We're Bound to Feel Better.

Corporate America, too, seems more ambivalent than ever about the Faustian bargain it made to kill national health insurance in the 1940s. The nation's automakers, for instance, once stood on the front lines in the battle against socialized medicine. Now they spend more on health care than steel. No wonder they're talking about "national solutions" to reduce the medical burden.

The political landscape is shifting, too. Leading Democrats now seem far more willing to discuss public insurance than was President Clinton in the early 1990s (who backed a market-based plan and saw it caricatured as a big-government monstrosity anyway). Both Sens. Barack Obama and Hillary Rodham Clinton are arguing that workers whose employers don't provide coverage should be able to buy into a public program modeled after Medicare. And they've emphasized that Washington will need to take the lead in developing the technology, information and standards necessary to improve the quality of care.

That's wise, because the only proven way to provide good affordable care to all Americans over the long run is to expand public insurance.

Don't take my word for it. The Lewin Group, a well-respected health-care consulting firm, recently estimated the potential impact of a health plan I've developed with the support of the Economic Policy Institute. The proposal -- which resembles the plans of the leading Democrats, whom I've advised -- requires employers either to cover their workers or to contribute to the cost of their workers' coverage. Workers whose employers make the contribution will be enrolled in a public plan modeled after Medicare. Like those covered by Medicare, they will have the option of purchasing regulated private insurance instead. According to the estimates, this proposal would cover all but a tiny sliver of the non-elderly population -- about half through the new federal system and half through employers. Yet it would actually reduce national health spending, cost the federal government an eminently reasonable $50 billion a year (about what the Medicare drug benefit costs) and save states and employers big money.

How is it possible to cover everyone without driving up costs? The one-word answer is "government" -- specifically, government's ability to lower service prices, streamline administration and get a better deal on drugs, thus reducing medical inflation over time. And these are only the direct savings. Reducing the burden of health care on employers will allow them to compete more effectively (and on a level playing field) with foreign producers. Just as important, making coverage affordable for everyone will allow people to change jobs or start their own businesses without the fear of catastrophic costs or the hassle, expense and inadequacy of individually purchased coverage.

Maybe socialized medicine doesn't sound so bad after all.

jacob.hacker@yale.edu

Jacob S. Hacker, a professor of political science at Yale and a fellow at the New America Foundation, is the author of "The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream."