Whatever bill emerges from Sacramento, it should include substantial market-driven elements and lean more toward opening consumer options rather than imposing new fees that effectively increase the public tax burden. A good outline of methods for accomplishing this can be found in the Pacific Research Institute’s recent position paper, “Curing California Health Care,” whose key principles are echoed in the Republican Party’s version of universal health care.

The PRI/GOP approach seeks to avoid new budgetary spending by focusing on tax credits and careful deregulation. It calls for California to join the 44 other states already conforming to federal law allowing individuals to pay all out-of-pocket health care costs, including insurance premiums, with pretax dollars sheltered in Health Savings Accounts. Low-income Medi-Cal clients could open similar accounts too.

All the Health Savings contributions would belong to the account owner for life and would be transferable through changes of employment. Saved funds could be applied to a statewide pool for purchase coverage choices from any insurer licensed in California.

The market-oriented plan would also give tax credits to employers who contribute to their workers’ Health Savings Accounts and to medical providers that give charity treatment or invest in technology upgrades. Portions of existing state budget allocations such as children’s First 5 Commission funding could be shifted to children’s health care uses.

High-cost emergency room treatment for minor medical problems would be greatly reduced by encouraging the spread of storefront-type community clinics that nurse practitioners were allowed to administer. Hospitals as well as private entrepreneurs would be free to open these convenient, lower-priced, extended-hour clinics.

Regulations restricting the flexibility of coverage offered by health plans and insurers would be eased, enabling budget-priced catastrophic-care-only policies and other innovative products to be marketed in response to demand. Consumers would no longer be forced to purchase only all-inclusive policies with 49 state-mandated benefits including in-vitro fertilization and drug and alcohol rehabilitation — a laundry list raising premiums by as much as one-third for services many Californians simply do not need.