Along with California and Maine, efforts to prove the economic feasibility of single-payer health insurance are taking place in several other states.
In Massachusetts, two Democratic candidates for governor, Robert Reich and Warren Tolman, have endorsed universal coverage. But efforts to revive a ballot initiative for universal coverage, which lost narrowly in 2000, were dashed last September when state Attorney General Thomas Reilly ruled a proposed initiative for 2002 unconstitutional.
An initiative in Oregon requires 6,000 more signatures by July 1 to put the Oregon Comprehensive Health Care Finance Act on the November ballot, according to petitioner John Partridge, M.D., a retired internist from Portland.
Although providers would remain independent agents in the private sector, the measure has met resistance from the Oregon Medical Association, he says.
"Basically the feeling is, the devil we know is better than the devil we don't know," Partridge says.
A similar ballot campaign in Washington state has been put on hold until 2004 while advocates try to garner more support from organized labor.
"We're talking about making healthcare a big issue in elections this fall, making candidates take a position," says Stuart Jeanne Bramhall, M.D., a Seattle psychiatrist.
"We have 12 different state agencies that make direct payment for healthcare services," she says. Add insurance companies and "that's an incredible amount of administrative overhead eating up money instead of paying providers."
In June, Vermont Gov. Howard Dean, M.D., a Democrat, outlined a proposal to create universal health coverage by introducing separate strategies for children, seniors and those in between.
Dean says Americans will accept cost constraints in exchange for universal care.
"People are not stupid," Dean tells Reuters Health. "They get the problem. They get the connection between wanting all the medical care they can consume and their premiums going up."
Modern Physician intern Christy Schinka contributed to this story.