In offering a comprehensive health care reform proposal, Gov. Ed Rendell is joining the governors of Massachusetts and California in taking bold steps to reform health care and provide universal coverage. Other states, including Vermont, Maine, Wisconsin and Minnesota, also are proposing serious changes to address the ongoing health care crisis.

That these states are taking the lead is an indication that the federal government has failed to address the issue — and that the health care system in the United States is broken.

Universal health care, or a single-payer system, is not what is being proposed by the states leading the effort to reform health care. But there are advocates, even within the health care industry, who support moving toward a federal, single-payer system that would provide universal coverage while also dramatically reducing burdensome paperwork related to managed care and insurance companies.

It is too soon to fully understand Rendell's multifaceted plan, but by making health care reform a centerpiece of his second term, the governor will put the health care issue front and center — where it deserves to be.

Few people are satisfied with the status quo in health care. Some exceptions might be found in major private health insurance companies making massive profits by restricting coverage, and the giant pharmaceutical companies that have been selling drugs to Americans at prices well above the prices paid by consumers in other countries.

By pushing for universal coverage, the goal is that previously uninsured people will be able to get preventive care that can help them avoid receiving care in the most-expensive place — a hospital emergency room.

Rendell's "Prescription for Pennsylvania" would require people making a certain amount of money to buy health insurance, and poorer people could buy coverage at reduced costs. There would be added costs to smaller employers that are sure to become an issue in the coming debate over Rendell's plan.

In fact, the Manufacturers' Association of Northwest Pennsylvania has already come out in opposition to Rendell's plan, complaining of more government mandates and rising costs. Likewise, the Commonwealth Foundation says Rendell's plan "misdiagnoses the health care problem,"and will be costly and unaffordable in the future.

In addition to expanding coverage, Rendell's plan appropriately looks to reduce costs. And some of those ideas will not be new to people living in and around Butler.

Rendell's plan calls for hospitals to take measures to reduce infections — and that is something Butler Memorial Hospital already is doing as one of a handful of hospitals in the state taking part in a program to track and eliminate infections.

It is well documented that hospital stays are much more expensive when a hospital-borne infection complicates and lengthens the patient's stay. Across the state, infections are responsible for about $3 billion in unnecessary health care spending. Taking on this issue, as BMH is doing, has the potential to cut billions of dollars from health care expenses across the state.

Another type of avoidable expense is incurred when incorrect medications are given to patients. Rendell's plan calls for accelerated implementation of new electronic systems to help prevent errors in prescribing medications — another area in which BMH will likely be something of a pioneer when it builds its new $100 million hospital tower on its East Brady Street campus.

Rendell also wants hospitals to develop less expensive ways of treating patients than in the emergency department, when the patient does not have a true medical emergency. Outpatient clinics, such as those proposed by BMH as part of its new expansion program, will be on track to reduce the cost of non-emergency care, just as Rendell proposes. Private specialty clinics, such as those now appearing in some drugstores and big box retailers, also could help to reduce the costly utilization of hospital emergency departments.

The governor's plan also envisions expanding the role of nurse practitioners as another way to reduce treatment costs. Allowing nurse practitioners and other non-M.D.'s to have expanded duties would save money by reducing the more costly time of treatment by a physician.

It is appropriate that Rendell's plan involves expanding coverage to the 767,000 uninsured Pennsylvanians, as well as reducing costs. Making progress on both sides of the health care equation is the only way to bring real change and financial relief to the health care system in Pennsylvania, and across America.

With a handful of states that now include Pennsylvania taking the lead in expanding coverage and reducing health care costs, it is possible a model for the federal government will emerge from one or more of the state programs. Powerful vested interests will oppose some aspects of the various state plans, but public sentiment and political will appear to have reached a tipping point that will finally overcome the political cowardice and influence of lobbyists representing industries profiting from the current, flawed system.

Rendell's plan is complicated and ambitious, requiring perhaps 40 different legislative actions. As always, the devil will be in the details. But by putting such a comprehensive plan forward, Rendell is starting a conversation that is long overdue about fixing the broken health care system in Pennsylvania, and America.