With his "Prescription for Pennsylvania,"Gov. Ed Rendell is proposing a comprehensive program to move closer to universal coverage while at the same time reducing health care costs. It is an ambitious agenda and one that will likely be opposed by those who profit from the current system as well as those who will feel financial pain due to the changes suggested by the governor.

The escalating financial burden of health care and increasing numbers of uninsured people is a crisis being addressed by bold new proposals in several states, notably California and Massachusetts. The growing number of uninsured people is the most talked about part of the crisis, but perhaps more widely felt is the burden that escalating health insurance premiums place on individuals and businesses that provide health coverage as an employee benefit.

With health insurance premiums expected to continue to rise at twice the rate of workers' wages, the current system is unsustainable. And there also are increasing concerns about the quality of the care delivered by the most expensive health care system in the world.

Writing in a Pittsburgh newspaper last Sunday, a proponent of a government-based, single-payer system wrote that Rendell was making a mistake by promoting a program that seems to ignore a major culprit in rising health care costs — the private health insurance industry.

Sandra Fox, of the Western PA Coalition for Single-Payer Healthcare, reminded readers that Highmark retained a $2.8 billion surplus as of the end of last year, and UPMC, the other major "nonprofit"health insurer, reported a profit of $321 millionfrom "patient, insurance and other operations."

Fox goes on to note that the CEOof Highmark makes $2.5 million a year and that an estimated 15 percent to 30 percent of health care premiums go to administrative costs, and that does not include CEO salaries, marketing, lobbying and political contributions.

Fox makes the point that the private health insurance industry is profiting from the current health care system and has a strong motivation to defend its position.

Whether coincidental or not, it is worth noting that among the major financial contributors to Rendell's $2.2 million inaugural bash in Harrisburg last week were major players in the health care industry. Donating $50,000 each to the party and earning the designation "patron" were Highmark, Independence Blue Cross, Capital Blue Cross and the University of Pittsburgh Medical Center (UPMC).

Among the lesser contributors, with a mere $25,000 check for the Rendell party, was Blue Cross of Northeastern Pennsylvania.

It will be interesting to watch as Rendell's plan for health care is debated, to what degree these highly profitable "nonprofit"organizations are a part of the remedy to fix health care in Pennsylvania. It is reasonable to expect Highmark, the various Blue Cross organizations and UPMC to fight to defend their turf — and their profits.

In the eyes of many, these so-called non-profits strain the definition of the word and, despite the obvious good things they do, they profit mightily from the status quo.

With the major health insurers and non-profit health organizations being financial supporters of Rendell, and no doubt many in the General Assembly, it will be important to watch to see what role and what sacrifices these organizations are compelled to make in Rendell's "Prescription for Pennsylvania."