Senate Majority Leader Bill Frist (R-Tenn.), in a wide-ranging health policy speech yesterday, said he wants to use the federal tax code to force wealthy uninsured Americans to enroll in high-deductible "catastrophic" plans that would cover the most severe illnesses or injuries.

Noting that close to one-third of the 44 million uninsured people in this country live in households with incomes above $50,000, Frist said it is unfair to expect taxpayers to pick up the tab for their care when an unexpected, expensive problem arises.

"I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children," he said in a luncheon address at the National Press Club. High-deductible insurance plans generally cost less than comprehensive insurance and do not kick in until after a person has spent $5,000 or $10,000 out of pocket on medical care.

Frist offered few specifics, acknowledging in an interview afterward that he was being intentionally vague about a notion that could be easily interpreted as a government mandate. He and aides hinted that one way to accomplish his goal would be to reduce the current $2,500 personal income tax exemption for upper-income people who did not submit proof they had at least catastrophic insurance.

On two hot-button issues -- stem cell research and legal prescription drug importation -- he said it is unlikely the Senate will take up any bills before heading home in the fall. He reiterated his assessment that Congress ought to revisit the Bush administration's limits on embryonic stem cell research in 2005.

Frist floated the idea of tax-free savings accounts for long-term care that would work much like 401(k) retirement funds. He also supports a federal health reinsurance program that would spread risk across a broader pool of purchasers. The plan, which he dubbed "Healthy Mae," resembles one announced several months ago by Democratic presidential contender Sen. John F. Kerry (D-Mass.).

With Election Day four months away, the surgeon-lawmaker framed his speech as a longer-term vision for health care. He predicted that by 2014 Americans will have their care managed through a fully integrated, privacy-protected electronic system. Patients and doctors could access their medical records from anywhere in the nation and consumers would be "empowered" to do their own health care shopping.

Within three years, he would like to see an electronic health record for everyone enrolled in a government health program, either as an employee or a beneficiary of programs such as Medicare and Medicaid. He said government "has a role" as both a large purchaser of health care and as the institution that must set standards for information technology.

Frist had much to criticize about today's health system, saying the "status quo is unacceptable." In his assessment, the system is performing poorly on the fundamental measures of cost, access and quality.

"Health insurance premiums are rising four times faster than incomes," he said. The number of uninsured keeps climbing, and recent studies have found that patients receive about half the recommended treatments for an array of common diseases, such as high blood pressure and diabetes. He bemoaned the fact that 5.6 million children eligible for government-subsidized health care are not enrolled.

"The bottom line is we can do better," he said.