Pittsburgh Post-Gazette editorial

In a nation where 46 million people have no health insurance and the federal government has abdicated its role on the problem, it was inevitable that states would begin to act. Now Gov. Ed Rendell wants Pennsylvania to join Massachusetts, California and others in trying to find its own solution.

The wide-ranging proposal he unveiled last week is not the single-payer method that deserves consideration on a national level. But it offers enough change -- through incentives, mandates and controls -- to be an effective state response.

On the surface, Pennsylvania's problem doesn't look so dire. About 767,000 adults are uninsured and, with 92 percent of its residents covered by health insurance, the state ranks seventh in the portion of those with health care. But a closer look shows even those robust numbers are precarious, with employers hit hard by the rising costs of worker health policies, employees having to pay a greater share out of their own pockets and too many Pennsylvanians living too close to the edge of a state of no insurance.

So Gov. Rendell wants to move from Cover All Kids, his initiative passed last year to make affordable insurance available to every child, to Cover All Pennsylvanians, in which nearly 50 pieces of legislation will be required to make changes on a host of fronts. We don't suspect every bill will be passed, or that each one will survive in original form, but the governor has launched a welcome and ambitious drive to confront the problem in a way that may actually work.

His multipronged approach seeks to improve access to health care by making it more affordable. By focusing attention on a variety of special interests, Mr. Rendell might even be improving the plan's political chances of success. For starters, we welcome his call to ban smoking in indoor workplaces, including bars and restaurants; extend the sales tax to smokeless tobacco and cigars; and raise the tax on cigarettes, the source of so many illnesses.

The plan would impose tougher regulations on the insurance industry to spare small businesses and individuals from sudden spikes in premiums. The governor wants to prohibit insurance rate-setting linked to health status, gender and number of claims filed. He wants 85 percent of every insurance dollar to provide health care -- meaning a hard limit on profit and advertising. He wants to give the state insurance commissioner the power to reject rate hikes.

The Rendell proposal would make changes in the health-care industry to bring down costs. The governor wants to exert pressure to reduce costly hospital-acquired infections and avoidable medical errors. He'd require hospitals to have non-emergency treatment centers that care for patients who don't need the high-cost attention of an emergency room. He'd allow health-care professionals like nurses, physician assistants and others to render treatments and services to the fullest extent of their training and skills, thus reducing reliance on higher-priced medical personnel. He wants the state to curb the duplication of expensive, underutilized treatment facilities in the same region.

At the workplace, Cover All Pennsylvanians would help small businesses provide health insurance to lower-wage employees at reduced rates. Companies that refuse would be hit with an assessment to help fund the insurance program. All uninsured Pennsylvanians, regardless of income level, would also be able to buy insurance at affordable rates and, eventually, may be required to carry coverage -- just as all Pennsylvania drivers must have auto insurance.

Although Gov. Rendell said various interests are bound to reject the aspects of the plan that hit them hardest, we are pleasantly surprised that the response, to date, has not been vociferous. There may be a reason for that.

Perhaps everyone -- consumers, business, hospitals and insurers -- finally agrees that something must be done, that 46 million Americans without health insurance leaves too many uncovered and, just as bad, too much cost for the rest of society to absorb.

The governor's plan is not only a healthy way for the state to address the problem, but it also has the makings of a progressive approach to covering all Pennsylvanians.

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