A novel approach to national health care reform sits in Congress, where it may or may not survive pending deliberations by a Senate-House conference committee. The proposal, a bill by Sens. Ron Wyden, an Oregon Democrat, and Orrin Hatch, a Utah Republican, won Senate approval in June. Its fate depends on whether the committee leaves it in the compromise Medicare bill now being drafted.

The proposed “Health Care for All Americans Act” would turn the search for a national health system on its head. Until now, various plans such as the ill-fated Clinton administration proposal, have been hammered out in detail and then presented for public approval or disapproval and then action by Congress. The Wyden-Hatch scheme would start with a broad study of what the American people want in a national health care system.

The first step, not more than 45 days after enactment of the law, would be the appointment of a Citizens’ Health Care Working Group. Its 26 members would include representatives of the uninsured, children, the mentally ill, the disabled, Medicare and Medicaid recipients, state health officials, large and small employers, labor, health insurance issuers, health care providers, various health care professionals, medical schools and community leaders. The Working Group would hold hearings to explore present systems and their capacity to expand coverage and lower costs and publish a “Health Report to the American People.”

Next, not more than one year after enactment of the law, would come a six-month nationwide series of community meetings for public input on how to expand coverage, balance costs and benefits, and define appropriate financial roles for individuals, businesses, and government. The meetings could use interactive technology to record and compile the views of, say, each table of ten people discussing with the help of a facilitator.

A report by the Working Group would pull together the preferences and information from the community meetings and present interim recommendations for 90 days of public comment. Then the Working Group would present final recommendations to Congress and the president.

Under the tight specified schedule, the whole process would take just over two and one-half years. The result, ideally, would be a national consensus. If it works as planned, the Wyden-Hatch plan could focus the voice of the American people so as to offset the furious lobbying by interests that profit from the present chaotic health care system and, for one example, wrecked the Clinton proposal before it had a fair hearing on the merits.

When the Senate approved the bill, Sen. Wyden said, “I believe this is the best opportunity in years to enact meaningful health reform, and I hope to see it move to the president’s desk.”

To get there, it first must emerge intact as one small part of the huge, complex and controversial Medicare bill.