Nonetheless, hundreds of Americans have written e-mails to the Citizens Health Care Working Group in a do-si-do of opinion that reflects the various concerns regarding how to pay for such a program and what it might look like.

The group has recommended that the federal government create a system for all Americans to have "a set of affordable and appropriate core health care services by the year 2012."

"In this report we have the politics, but we don’t have the power," says Helen Darling, president of the National Business Group on Health (Darling is not a member of the Citizens Health Care Working Group). "Nobody minds politics, but if you don’t have the power, people are just talking to each other."

The report is considered by the group’s 15 members to be a policy framework for Congress, and offers little in the way of detailing how to pay for universal coverage. Employers, think tanks and insurers have not yet weighed in publicly on that issue, and the group’s executive director, George Grove, says its members are "very well aware" of the criticisms.

"They are certainly getting the message," says Grove, former deputy inspector general for evaluations and inspections for the U.S. Health and Human Services Department. The criticism that the plan did not include a way to pay for itself is "a prominent comment and they have to pay attention to it," Grove says of the board.

The American Medical Association, while not commenting on the report, voted June 13 to endorse a policy that would require individuals who make more than five times the federal poverty level—$49,000 annually for an individual and about $100,000 for a family of four—to purchase health insurance. The policy would reduce the number of uninsured Americans, which stands at 46 million, by about 5 million, the AMA said.

Despite criticisms that the report lacks detail on how to finance a universal health care system, the effort helps "keep health care and health coverage at the forefront of national thinking," says Mila Kofman, an associate research professor at the Georgetown University Health Policy Institute.

A program that protects people against the financial risk posed by major illness could alleviate the financial pressures incurred by employers, who effectively subsidize health care not covered by Medicaid or Medicare at a cost of $40 billion annually, Kofman says.

"If we get to the point where everybody pays their fair share, then employers would benefit from that because they are fronting a bigger bill than they should," Kofman says.

Advocates of consumer-driven health care have been particularly concerned that the report signals a return to greater managed care by insurance companies. Steve Barchet, a retired physician and a founding member of advocacy group Consumers for Health Care Choices, attended a town hall meeting held by the working group in Seattle that he criticized as being full of wishful thinking but short on pragmatism.

"I haven’t a clue as to what a universal health policy is," he says. "If it means everything for free, I can’t support anything that comes even close to that. That’s nirvana, and nirvana has to somewhere along the line face reality and economics."

The report, in offering few details, leaves open the possibility that a core set of health care benefits could include the high-deductible health plans favored by advocates of consumer-driven health care.

"I think it’s too early to sweep this under the rug," says Paul Sullivan, an assistant vice president with the research and technical services group at Aon Consulting. "The commission has done a lot to include people and give people the opportunity to comment. It’s not counting any people or any one philosophy out."

The working group proposal to insure all Americans will meet three more times before issuing its final report in late September. The president will then have 45 days to make comments to Congress, a deadline that comes just after the midterm elections.

—Jeremy Smerd