Nine years ago, then-First Lady Hillary Clinton put together a comprehensive healthcare proposal that crashed and burned probably a key factor in Republicans taking over the US House a year later. Since then, various attempts to reform national healthcare have also faltered.
Now, states are taking the lead in considering universal healthcare providing government medical care to everyone. Thirteen states are on this path, with Oregon in the forefront. In November, voters here will consider a revolutionary ballot measure that would use tax dollars to provide full healthcare for every state resident.
It would raise taxes, but proponents say it also would save billions of dollars a year mainly by reducing administrative costs from about 25 percent down to 5 percent. Oregon's measure also would provide healthcare to several hundred thousand people now without health insurance, many of them children.
"People are really ready for a big change in the system," says Britt McEachern of Health Care for All Oregon, the grass-roots group promoting the ballot measure. "Everybody we've talked to has a problem with health insurance or they know a friend who has a horror story."
The proposal comes at a time when the numbers of those without health care across the United States is approaching nearly 40 million, when Americans are spending about $4,700 per person on health care each year (almost twice the level of other countries), and when the quality of healthcare in the US is ranked by the World Health Organization as 37th below that of many far less affluent countries.
But opponents from around the US, led by insurance companies and other business groups, can be expected to mount a large and expensive campaign to fight the Oregon measure. After all, opponents of the Clinton plan used the very effective "Harry and Louise" television ads to kill that proposal.
"Its sky's-the-limit coverage would mean skyrocketing costs," warns Associated Oregon Industries, a lobbying group that represents some 20,000 companies. "Taxes to pay those bills will hurt individual taxpayers, cripple Oregon businesses, and cost Oregon jobs."
Opponents also point to Canada's single-payer health care system where some people now have to wait months for certain medical procedures or travel to the US for treatment.
Some Canadian provinces are thinking about privatizing the system. Others say this is because the level of health-care spending is set by lawmakers beholden to campaign contributors including health insurers who prefer a private system.
Supporters of universal health care may face an uphill battle, but the political landscape has changed considerably from the early 1990s.
The debate comes at a time when Americans, particularly in today's economic climate, are increasingly worried about losing health benefits.
It also comes as states faced with the requirement to balance their budgets and having to cover medical costs growing much faster than inflation are cutting health programs for the poor.
Some 40 states have reduced benefits under Medicaid, raised the amount that beneficiaries must pay (as deductibles or copayments), or have raised the eligibility requirements leaving increasing numbers of people without health insurance.
Healthcare advocates estimate that 2 million Americans lost their health insurance last year.
A recent government-sponsored study in California concludes that government-operated universal health care would cost less than the present system. Studies in Massachusetts also show big savings.
Oregon is known for its distinctive politics on health issues including physician-assisted suicide and a state program providing healthcare for many working-class people who don't qualify for Medicaid but can't afford private coverage.
Measure 23, or the "Oregon Comprehensive Health Care Finance Plan," as the ballot initiative is called, would be funded by progressive income and payroll taxes with a maximum of 8 percent of an individual's taxable income.
Those earning no more than 150 percent of federal poverty guidelines would not have to pay the extra tax. In essence, the new fund would replace health-insurance premiums, copayments, deductibles and out-of-pocket expenses for healthcare.
The plan would be administered by an independent, nonprofit corporation run by a 15-member board (five members appointed by the governor and two each elected from the state's five congressional districts), which would negotiate contracts with healthcare providers.
The healthcare system would include all state residents (residency likely would be determined the way it is in the state university system), and it would cover the full range of physical and mental-health services, including long-term care and alternative forms of treatment. There would be no exclusions for preexisting conditions.
All eyes will be on Oregon this fall to see if it makes what for the United States would be a revolutionary leap.
"This is a very, very ambitious initiative which, it seems to me, will draw enormous spending in opposition by the insurance industry, because if this were to be approved it would put the private insurance operators out of business," says William Lunch, professor of political science at Oregon State University in Corvallis.
"Oregon may be a relatively small, out-of-the-way place," says Dr. Lunch, "but because of the national attention it gets for its policy innovations, there are quite broad implications that go well beyond this state in this matter."