You'd think that when everyone agrees a large problem exists, a rush of energy and competition would go into solving it.
But since the failure of President Clinton's health plan in 1994, politicians have gone to ground rather than address the increasing number of Americans -- now 44 million -- without health insurance. They are allergic to words such as "comprehensive," "national" and "universal."
That's about to change.
Democratic presidential candidate Bill Bradley plans to unveil a broad health care proposal next month to begin establishing his credentials as a "big ideas" candidate. Vice President Gore -- up to now ahead in the big proposals race -- will have to respond.
And in New York, presumptive Senate candidate Hillary Rodham Clinton will be questioned fiercely about what went wrong with the health security plan she championed and what she'd do now. You can bet most voters would rather hear her out on health care than on her marriage. And however she explains her failures, she shouldn't disown her goal of trying to deliver health insurance to every American.
Meanwhile, the experience of states in coping with the problems of the uninsured is percolating back to Washington. Thanks to the Children's Health Insurance Program, passed by Congress in 1997, we're learning a lot about what works and, alas, what doesn't.
Some states really are serving as laboratories for innovation. Here in Rhode Island, the RIte Care program boasted last month that it had cut the ranks of the uninsured by 12,000. The state's managed care plan streamlined and replaced various programs for low-income people, including Medicaid. It now covers 86,000 people.
That's impressive news. The plan benefits those who would otherwise fall through the cracks of the health system, said Tricia M. Leddy, RIte Care's administrator. "They're self-employed, they're waitresses, cabdrivers," she told the Providence Journal's Felice Freyer.
But Freyer noted that the number of uninsured here "may swell faster than RIte Care can, as health insurance premiums soar out of many people's reach." Even the states doing the most may not be able to do enough.
This week the president expressed concern that states aren't taking full advantage of the Children's Health Insurance Program, which authorized $39 billion in federal spending over 10 years to cover the more than 10 million kids who lack health insurance. So far, only 1.3 million children have been signed up for coverage.
The feds singled out some states -- Nebraska, Ohio and South Carolina -- for exemplary efforts to cover kids. But local officials have complained that overlaying a new federal program onto Medicaid may be confusing administrators and potential recipients alike.
Such experiences may bring the word "comprehensive" back into vogue. Jacob Hacker, a fellow at the New America Foundation in Washington, thinks it's time to create a federal program modeled after Medicare to cover children.
"Family coverage is already rapidly declining," he says, as employers drop family plans in favor of policies that cover only their individual employees. Hacker, who wrote an appropriately titled book on the Clinton plan, "The Road to Nowhere," says covering children is urgent.
"It would rationalize the market because employers wouldn't think there was an extra cost to hiring people with children," he says. Friends of family values ought to worry when the market starts providing incentives for employers to avoid hiring parents. Universal coverage for children, he adds, would "balance out" the government's commitments to the young and the old.
To achieve universal coverage for adults, it may be possible to harness a conservative idea -- vouchers or tax credits -- to a traditionally liberal purpose. Pushed for years by Stuart Butler of the Heritage Foundation, the voucher approach steadily gains new supporters as other efforts to achieve universal coverage fail.
As part of a grand compromise, the vouchers might be used not only in the private insurance market but also to buy into Medicare or the various private plans offered by the federal employee benefit system. In effect, the government would become the insurer of last resort, while still leaving large parts of the private market intact.
The lesson from the failure of the Clinton plan is not that achieving universal coverage is impossible. It is complicated. A perfect health care system will never exist. Trial and error is the best we'll do. But we won't even get that far if we don't start trying again. States such as Rhode Island already are, and they deserve help.