Dueling Health Plans

THE momentum began with Harris Wofford.

After he won a United States Senate seat in Pennsylvania with a campaign built around a call for national health insurance, politicians took notice. People are insecure about their health insurance, and the issue can turn a vote.

Now there is a diverse spectrum of proposals before Congress for remaking the health-care system.

All of them expand the regulatory power of government in the health-insurance market. All of them - from the most liberal Democratic plan to the most conservative Republican - require the socializing of health-care costs by limiting or banning the ability of insurers to discriminate based on health status.

The most radical proposal for change, the single-payer plan introduced by Rep. Jim McDermott (D) of Washington and Sen. Paul Wellstone (D) of Minnesota, is the most like that of other wealthy industrial countries. It may also be the closest proposal to what Pennsylvania voters had in mind when they elected Mr. Wofford.

The most cautious proposal, the House Republican plan introduced by minority leader Robert Michel of Illinois, nips and tucks at the rough spots but leaves the current system essentially intact.

Most of the proposals put some stronger government controls on the legal system as well as insurance in an effort to control malpractice costs. With the exception of the single-payer proposal, all the plans would require malpractice charges to first be heard in alternative dispute resolution forums before going to court. All the plans but single-payer and Clinton would limit court awards for noneconomic damages (so-called pain and suffering) to $250,000. Most cap lawyers' fees at 25 percent.

Only the single-payer plan and the Clinton plan seek to guarantee up front that all Americans are covered with comprehensive health benefits. The other plans would phase in universal access.

Sen. Phil Gramm (R) of Texas seeks to reward responsible behavior. His plan allows higher insurance rates and lower subsidies to people who smoke, drink excessively, or become overweight.

Under most of the proposals before Congress, the medical bill that can clean out a life's savings would be obsolete, even for the most unprepared.