“Prescription for Pennsylvania” included a ban on smoking in public places, a reduction in the rate of hospitalization for chronic diseases and an expansion of the role nurses play in treating patients. He even framed his proposal to provide universal access as “a form of cost containment,” emphasizing that 6.5 percent of every health-insurance premium in Pennsylvania went to subsidizing care for the uninsured, often in emergency rooms.
Mr. Rendell is learning, however, that to contain costs is eventually to pluck dollars from someone’s pocket. His plan has incited protest from hospitals, doctors, insurers and small businesses, each of them finding something to detest. Other big-state governors who are leading a second wave of health care overhaul — after recent expansions of coverage in Maine, Massachusetts, and Vermont — are also making strong comments about runaway costs, as are presidential candidates in both parties.
In Illinois, Gov. Rod R. Blagojevich, a Democrat, is selling his health care plan by forecasting that the savings generated by better management of chronic diseases and expanded use of electronic records will exceed the cost of extending coverage to 1.4 million adults. Mr. Blagojevich is trying to revive his plan after legislators rejected a proposal to pay for extended coverage with a tax on gross business receipts.
“The key is, Can you package the reforms to show what impact it’s going to have on people with insurance so that you can motivate labor and big business?” said Kenneth E. Thorpe, a professor of health policy at Emory University who is advising Mr. Blagojevich. “In Illinois, we showed that every $1 in state spending would yield $2 in savings for people with private health insurance. That refocuses the debate.”