WASHINGTON -- It turns out that overhauling the health care system isn't just for presidential candidates.
While front-runners in both parties float ideas for expanding access to drugs and treatment, two Maryland Democrats - Sen. Benjamin L. Cardin and Rep. Chris Van Hollen - are serving up proposals of their own.
Van Hollen introduced a measure Wednesday that would allow states to negotiate directly with pharmaceutical companies to secure discounts on prescription drugs for low-income residents. Cardin proposed legislation this week that would require all uninsured Americans to enroll in a health care plan and would require the federal government to work with states on developing low-cost options.
"We have the highest quality in the world of health care," Cardin said. "And in Baltimore, at the University of Maryland Medical Center, at Johns Hopkins University, you can see people from around the world coming to Maryland in order to get their health care needs met and train their health care professionals.
"The problem is our health care system is way too expensive. And overall, we don't have the results to reflect the amount of money that we spend."
The Cardin and Van Hollen proposals join the swirl of ideas, in Congress and in the 2008 campaign, to address what polls consistently identify as the nation's leading domestic concern. Insurance premiums rose 87 percent from 2000 to 2006, according to the Kaiser Family Foundation. The number of Americans without coverage has grown to about 45 million.
Cardin compares his plan to laws that force motorists to purchase automobile insurance. His bill would require all uninsured Americans to enroll in a plan, while directing the Department of Health and Human Services to work with state officials to develop three low-cost options for those who earn less than four times the federal poverty level, or about $82,000 for a family of four.
Cardin says the measure would reduce the number of uninsured Americans by two-thirds - an important first step toward universal coverage. "It clearly is not the end of health care reform," he said. "It would be the beginning of health care reform."
Van Hollen's proposal would allow states to harness the collective bargaining power of their lower-income residents to negotiate group discounts on prescription drugs. In 2005, Gov. Robert L. Ehrlich Jr. signed legislation to pursue such price breaks, but the effort was blocked by the Bush administration.
Van Hollen's proposal would apply to Americans living at less than three times the federal poverty level - $62,000 for a family of four. He said it would allow the state of Maryland to negotiate a 40 percent discount for about 500,000 residents.
The legislation "says we're going to trust states," said Van Hollen, who represents Montgomery County. "We don't think that they should have to come to the federal government and beg for permission to provide better access to affordable prescription drugs for their people."
Van Hollen's and Cardin's proposals are two of many circulating in advance of health care hearings Congress is expected to hold this year. Cardin, who backed President Bill Clinton's failed health-care overhaul of the early 1990s, acknowledged the difficulty of seeing his or any proposal enacted into law, particularly in an election year.
"I think there really is a desire to move this issue forward," he said. "Now, am I optimistic that this will be accomplished in 2008? I'm going to try. But I know that it's been a long time in coming, and I really want this issue teed up for national debate."