The question is whether Oregonians are willing to pay higher taxes for a plan so generous it would cover even acupuncture and massage therapy.
"What we are proposing is ambitious and audacious, but we believe the health care system now is in a crisis," said Mark Lindgren, spokesman for the Health Care for All Oregon campaign, sponsor of Measure 23.
Under the existing system, he said, an estimated 423,000 of Oregon's 3.3 million residents have no health insurance - about 70,000 of them children. Nationally, the number of uninsured is about 41 million.
The Oregon plan would be financed by a new payroll tax of up to 11.5 percent on businesses and an increase in personal income taxes. The top rate would rise from its current 9 percent to as high as 17 percent.
No independent polls have been released on the measure, but it is facing strong opposition from business, insurance and health care industry groups, who fear it will lead to runaway spending and wreck the state's economy.
"It's the richest benefits package known to man," said J.L. Wilson, head of the Oregon chapter of the National Federation of Independent Business. "Under this bill, you would have to pay for people to go to a massage therapist four days a week because it's deemed `medically necessary."'
Lindgren put the cost $19 billion a year - more than the entire current state budget of about $16 billion. About $7 billion of the cost would be covered by the payroll tax, and $4.9 billion by higher income taxes. The rest would come from shifting state and federal health care dollars to the new universal system.
Oregon has gained a reputation for tackling difficult health-related issues in recent years. Voters in 1996 approved the nation's only law allowing physician-assisted suicide. In 1998 they approved the medicinal use of marijuana. In 1989, the Legislature enacted a groundbreaking health plan that extended insurance to thousands of poor people; the state drew up a master list of hundreds of diseases and treatments, ranking them in order of importance, then drew a cutoff line below which the state would not provide coverage.
Measure 23 is backed by the Cleveland-based Universal Health Care Action Network, whose spokeswoman Rachel DeGolia sees the Oregon effort as picking up where Hillary Rodham Clinton left off a decade ago with her push for universal health care.
"It was dead in the water from the beginning" because of opposition from the health care industry, DeGolia said. "That's the reason we think this is going to have to happen at the state level first."
Supporters hope passage of Oregon's measure will lead to similar efforts in other states.
People in Oregon would not be required to get rid of their private or group insurance, but most would probably do so since they would be paying for the universal system anyway, Lindgren said.
He said that while many people would pay higher taxes, much of that would be offset because they would no longer have to pay premiums, co-payments, deductibles and other out-of-pocket health costs.
Opponents say the residency requirement is so loose that seriously ill people without insurance would move to Oregon just to take advantage of the program. New arrivals would merely have to declare their intention to live here.
"It would take more to get a hunting license in Oregon than it would take to get access to full health benefits," said the NFIB's Wilson.
Opponents also warn that it would cover all treatment deemed "medically necessary" by any state-licensed, certified or registered health-care practitioner. Also, the measure does not contain any limits on coverage and does not spell out whether there would be any exclusions for experimental procedures or devices.
Lindgren said those points were deliberately left vague so that a 15-member state board that would be created to oversee the program could make those decisions later.
He disputed warnings of runaway costs. Among other things, he said, people who lack insurance are a drain on the system because they often leave minor conditions untreated until they become major problems requiring expensive emergency room treatment.
Barney Speight, a former state health administrator, warned that Measure 23 is bad medicine. "It might be able to achieve universal coverage in the short term," he said, "but in the long term it could destroy Oregon's economy."
By Brad Cain By Brad Cain