In 1991, appointed Sen. Harris Wofford (D-Pa.) won a special election for his seat and put the issue of health care reform on the national agenda. Next year’s elections offer someone that golden opportunity once again.

In the past 14 years, the need for comprehensive reform has become ever more compelling. As the National Coalition on Health Care reported last month, the number of uninsured Americans is expected to rise from at least 45 million now to 51 million by 2006.

[IMGCAP(1)]Health care costs are rising at double-digit rates, putting a drag on economic growth by raising insurance rates, cutting into corporate investment and profit and consuming more of the disposable income of workers and retirees.

And despite growing attention being paid to the problem of poor quality in health care, NCHC’s president, Henry Simmons, cites estimates that medical errors rank as the third leading cause of death in America, just behind cancer and heart disease.

NCHC, consisting of 95 of the nation’s largest businesses, unions, pension plans, non-profits, churches and medical groups, released a new study showing that any of four models of comprehensive reform could save the nation hundreds of billions of dollars over a 10-year period, as well as improve quality and reduce the ranks of the uninsured to zero.

In 1991, Wofford recalled in an interview, he had no specific health care plan to recommend, but he gained political traction by pointing out that since the Constitution guarantees all criminal defendants a lawyer, the United States should also guarantee the right of sick people to see a doctor.

Another line that resonated, he said, was that the government paid 75 percent of the health premiums of Senators and other government workers, and ordinary Americans deserved coverage as good.

Partly on the strength of the health issue — and having his campaign managed by the then-little-known James Carville — Wofford erased a 47-point deficit and won the special by 10 points, attracting the notice of presidential hopeful Bill Clinton.

Wofford joked that he recently learned from Harvard President Larry Summers that his ’91 success also attracted the notice of Cuban dictator Fidel Castro, who told Summers, then a World Bank official, that “‘maybe now America will get universal health coverage.’”

The United States doesn’t have it yet — and the NCHC’s models show that the U.S. doesn’t have to resort to Cuban-style socialized medicine to get it.

The group’s options include: (1) a combined employer and individual mandate, (2) expansion of existing public programs such as Medicaid to cover segments of the uninsured, (3) creation of a new targeted government program, perhaps modeled on the Federal Employee Health Benefits Plan and (4) establishment of a new publicly financed system.

“I emphasize,” Simmons said in a press conference on May 23, “that none of these entail a government-run system. But to assure that everyone gets coverage, we believe that participation must be required and subsidies must be provided to those who are less affluent.”

NCHC officials say that option 4, involving the largest initial government outlays and long-term savings, conceivably could allow for private insurance — though it might also resemble Canada’s government insurance system. It would not, however, resemble Britain’s (or Cuba’s) program, in which doctors are government employees.

As history shows, there certainly are political dangers in trying to enact wholesale reform of the U.S. health care system. The Clinton proposal, championed by then-first lady (now Sen.) Hillary Rodham Clinton (D-N.Y.) and backed by Wofford, was opposed by Republicans and the health insurance industry as too government-heavy and was defeated in a Democratic Congress.

That defeat, combined with a controversy that divided Pennsylvania’s Democratic party over the plan’s coverage of abortions, caused Wofford to lose his race for re-election in 1994 to then-Rep. Rick Santorum (R).

“My election convinced Clinton that this should be a major issue in his campaign,” Wofford recalled, “and it convinced Congress that health care was a much bigger, hotter issue than anyone estimated and that they were going to have to do something about it.”

But he added, “My defeat showed that this was a hot rail that can burn you, too.”

Politically and on the merits, advocating comprehensive health reform should be a net benefit in 2006 — and 2008, too — probably more for a Democrat.

President Bush and GOP health experts such as Senate Majority Leader Bill Frist (Tenn.) are wedded to an incremental approach emphasizing tax breaks and legal changes that would enable individuals and small companies to buy their own insurance and pay attention to the costs.

According to Simmons, “a number of those ideas would do something. It’s not that they wouldn’t do anything. But given the trajectory of the crisis, those gains would be wiped out less than a year after their enactment.”

Even though a million workers have taken advantage of one of Bush’s signal ideas — tax-benefited health savings accounts — all of Bush’s proposals would cover fewer than 10 million of the nation’s 45 million uninsured.

Simmons argues, too, that Bush’s emphasis on Social Security reform is short-sighted. “We’re not saying not to reform Social Security,” he told me. “But its fiscal shortfall will cause a 30 percent cut in benefits 40 or 50 years from now.

“Right now, in 2005,” he said, “there are at least 45 million Americans who have zero percent health benefits. Zero percent!”

So far, even though the NCHC includes such giant entities as General Electric, the AFL-CIO, AARP, several state pension systems and some big insurance companies, its models have yet to be converted into legislation — or even a stump speech.

Sen. John Kerry (D-Mass.) and Rep. Henry Waxman (D-Calif.) are sponsoring a plan to cover 11 million uninsured children, but that would be only a step toward comprehensive coverage.

If and when a politician goes all the way, there will be renewed controversy over costs, government control and an NCHC proposal for “containment” of insurance premiums, which might be labeled “price controls.”

Still, the problem is real. It’s time that health care reform is seriously debated again. And an election campaign is a good place to do it.