But the "reforms" brought huge increases in insurance premiums and new limits on coverage. Premera Blue Cross, then the largest carrier in Washington's individual market, for example, raised premiums on its once-most popular plan by 78% between 1995 and 1998 — about 10 times the rate of medical care inflation. And the plans stopped covering maternity care, prescription drugs, and mental health, all of which they had covered before.

Citing mounting losses, the major carriers stopped writing new policies in the individual market, and people couldn't find individual policies at all in many parts of the state.

Seeing rising costs and a rising number of uninsured, the state pulled back on its reform agenda of aggressive government intrusion into the health insurance market.

The Washington Policy Center, the state's leading think tank, has followed these issues closely and held its annual health care conference last week.

People are anxious to hear about what is going to happen on the national scene, where many of the proposals look a lot like the ones they already have tried.

I moderated a panel on state efforts at reform where the audience heard about the efforts and struggles in Wisconsin, California, and Massachusetts in trying to achieve universal coverage. The bottom line: It is a much heavier lift and much more expensive than political leaders had anticipated.