After having tried both health care regulation and competition, Dr. Ron Kaufman thinks the United States is ready for another hard look at a third approach it considered and rejected more than a decade ago: government-sponsored health insurance.

"I know I wouldn't have said this 10 years ago," said Kaufman, for 17 years one of the city's leading health care administrators, the last 10 as vice president for medical affairs at George Washington University.

"I always thought that free enterprise was the American way, and we hadn't given it a chance in health care," Kaufman said. "But now we have. Social goods, I've come to the conclusion, don't lend themselves to the free market."

It seems surprising, this attitude of a man who, from when he arrived at GWU in 1970 to his retirement at the end of last month, led the sometimes staid university medical community into the age of health care competition.

In 1972, George Washington started one of the city's first health maintenance organizations, to be followed a decade later by a contract with Aetna Choice, one of the area's first "preferred provider organizations." It was Kaufman who pushed the university's three-year flirtation with an investor-owned hospital system, a controversial tactic criticized by many others in local medical circles.

And during Kaufman's tenure, above all, the George Washington University Medical Center was transformed from virtually a community hospital to a full-fledged teaching facility with experts in all the specialties and subspecialties of medicine.

Kaufman, a 57-year-old physician known by other doctors for his sometimes prickly and plain-spoken style, retired from the university last month after accepting a position as vice president for health sciences at the University of South Florida. A few days before he packed his bags, Kaufman gave a valedictory interview over coffee and doughnuts in his hospital office overlooking Washington Circle. On the wall hung an apt sign: "Most People Fear Change More Than Disaster."

Kaufman talked mostly of the enormous changes wrought in medicine during his 17 years in Washington -- and his belief that neither intensive government regulation, for instance through health planning agencies that oversee numbers of hospital beds and expensive equipment, nor free-market competition has solved the crucial problem of universal access to health care. Kaufman pointed to the estimated 50 million Americans with no -- or inadequate -- health insurance, a number experts say is growing.

"If we're approaching 20 percent of the people in a system not adequately covered, I think its quite possible that this country is going to reaffirm that health access and health well being is as much a right in 1980 and 1990 as it was in 1960," Kaufman said. "I believe that health care is a right just like education, police protection and all the rest, and it should be available to everyone irrespective of their ability to pay."

While Kaufman stopped short of advocating a specific solution, he displayed a powerful predisposition to some sort of government-sponsored and regulated health insurance system on the order of the Canadian or other Western-bloc systems. Such a system, he said, would not only guarantee access to health care for all, it would provide a more rational way to budget health care costs.

"All this business about competition and regulation didn't work," said Kaufman. "Regulation did not control costs. And there is pretty good data to show that competition increases costs," he added, citing a recent study showing that, among other things, competition encourages hospitals to buy expensive equipment that tends to raise their costs.

Kaufman rejected the notion that the popularity of new health insurance options, like health maintenance organizations, will have a substantial impact in slowing the inflationary spiral in health care. Although these plans can be quite successful in limiting the amount of unnecessary hospitalization, he said, they do nothing to address the fundamental factors driving costs upward, such as the continuing introduction of technologies and the aging of the population.

With health care now consuming about 11.5 percent of the country's gross national product, Kaufman added: "The intrinsic question is how much ... the American people is willing to put into health care. I'm not endorsing Canada. But what you can do with a Canadian-like system is ... budget {health care costs}. And you can determine through legislation what it will be, and you can say we will spend X million dollars per year on health."

"If you look at the Canadian system," Kaufman continued, "it has been pretty successful. Its been good for the people. It has not harmed science. Their {medical} education is still excellent. The only downside is that they are a little bit behind us in technology, but not so far behind us that it has affected outcomes."

If this view proves controversial among his peers, it would not be out of character for Kaufman, who during his tenure in Washington often butted heads with doctors and others in the D.C. medical establishment. He concedes that conflict, but offers a caveat: "I hope that one of the things that people remember about me is I told them what I was going to do. I didn't suddenly pop things on them and say, 'Surprise!' "

In his early years at the university, he served as medical director of the hospital, where he elicited a bitter reaction from many private physicians practicing there who felt threatened by his efforts to build up the full-time teaching staff. A few years ago, Kaufman stirred up many of the same passions when he struck a deal with Aetna Life Insurance Co. for GWU's full-time doctors to participate in the insurer's new preferred provider plan. Again, the private doctors believed they were shut out.

But Kaufman's most controversial move was undoubtedly the protracted negotiations he initiated with American Medical International, the California health care conglomerate that sought an equity interest in GWU's hospital. GWU approached the for-profit company in an effort to raise much needed capital to renovate the hospital, but those negotiations collapsed after AMI's fortunes soured last year. Now GWU will look for new capital by selling tax-exempt bonds.

Although Kaufman was subjected to intense criticism from opponents of the profit motive in health care, today he offers no apologies for that.

First of all, Kaufman said, GWU emphasized throughout its discussions with AMI that under any deal it would have to maintain control over the clinical and academic programs in the hospital. Kaufman also argued against a commonly held view in some parts of the medical establishment that, as he put it, the for-profit chains are "intrinsically evil."

"That is an exaggeration," he said. "If you look at the health care sector, the only not-for-profit sector is hospitals. Doctors are for-profit. Most of the HMOs these days are for-profit. Insurance companies are for-profit. Drug companies are for-profit.

"Are they intrinsically evil? Probably not. Do they need to be controlled? Of course ... but I could never convince myself that whether there was a shareholder or not made that much of a difference. When I've dealt with boards of directors here or anywhere else, they insist and have to insist that the facility over which they are responsible has to be at least one dollar in the black. There are no money machines."