Consensus emerging on universal health care: ; Spectrum of groups agree massive federal intervention required

WASHINGTON - After decades of failed efforts to reshape thenation's health-care system, a consensus appears to be emerging inWashington about how to achieve the elusive goal of providingmedical insurance to all Americans.

The answer, say leading groups of businesses, hospitals, doctors,labor unions and insurance companies - as well as senior lawmakerson Capitol Hill and members of the new Obama administration - isunprecedented government intervention to create a system ofuniversal protection.

At the same time, those groups, which span the ideological andpolitical spectrum, largely have agreed to preserve the employer-based system through which most Americans get their healthinsurance.

The idea of a federal, single-payer system patterned on those inEurope and Canada, long a dream of the political left, is nowvirtually off the table.

Rejected as well is the traditionally conservative concept,championed by Sen. John McCain during the presidential campaign, ofreforming health care mainly by giving incentives for more Americansto buy insurance on their own.

There also is a widespread understanding that any expansion ofcoverage must be accompanied by aggressive efforts to bring downcosts and reward quality care. And key players in the health-caredebate increasingly back a massive investment of taxpayer money forhealthcare reform despite the burgeoning budget deficits.

Beyond those areas of basic agreement, the details of what wouldbe one of the most momentous changes in domestic policy since WorldWar II remain vague.

As a presidential candidate, Barack Obama embraced both expandedinsurance coverage and preservation of the job-centered system, butsince he won the White House he has provided few specifics about hisplans once he takes office.

Disagreements over specifics could again lead to a stalemate.Even the most sanguine advocates of sweeping reform concede thatdifficult negotiations lie ahead.

But what is taking shape is a debate very different from previousdiscussions about what America's health-care system should looklike.

"A lot has changed," said Karen Ignagni, president of America'sHealth Insurance Plans, or AHIP, a leading trade group whose membershelped kill the Clinton administration's healthcare campaign in theearly 1990s.

AHIP is participating in talks with other interest groups tobuild consensus before Obama takes office in January and Congressbegins debating any healthcare legislation.

Among the issues to be decided as more concrete proposals emergein the months ahead is whether the roughly 46 million uninsuredpeople in the U.S. will be pushed to buy private coverage or will beenrolled in a government insurance program, as some consumer groupswant.

Hospitals and doctors fear another public program would reducewhat they are paid, as Medicare and Medicaid have done. Insurersworry they could lose customers to the government.

Also unresolved is what mechanisms might be created to forceindividuals or businesses to get insurance, both potentiallycontentious subjects.

And few have tackled how the government will control costs andset standards of care, proposals that raise the unpopular prospectof federal regulators dictating which doctors Americans can see andwhat drugs they can take.

Republican lawmakers, still reeling from their election daylosses, have signaled discomfort with a major expansion ofgovernment spending, a position many in the GOP hope will helpreturn the party to power.

Nonetheless, the current agreement on principles contrastsmarkedly with previous reform efforts. Today, many of the keyplayers in the debate see the importance of preserving elements ofthe current health-care system that many Americans say they like.

"There is a growing understanding that you have to give peoplechoice and you can't take away what they have," said Ron Pollack,head of Families USA, an influential advocacy group for health-careconsumers that is working with a diverse collection of interestgroups to build consensus. "One of the big no-no's is that you mustnot ever threaten the coverage that people have."

Fifteen years ago, there was much less agreement about preservingan employment-based system that now insures about 177 millionpeople.

Opponents of President Clinton's plan were able to sink it byraising the specter that government would take away consumers'choices in a new system that would force them into inferior healthinsurance.

But now the prospect of bold government action to address thehealth-care crisis appears to have been accepted far more broadly bymany of those involved in the debate.