In a luncheon address this week at the American Enterprise Institute, Health and Human Services Secretary Michael Leavitt offered a note of optimism: Expenditures for the Part D prescription drug benefit were lower than expected and hospitalizations were down last year. He said he believes there is a correlation: "Access to the right medicines can lead to fewer hospitalizations."

He described a vision for a 21st century health care system with government as the "organizer" rather than the "proprietor" of our health care system. You can hear his speech in which he offered warnings against expanding the role of government, especially through Medicaid and SCHIP.

"In nations where government dominates the health care system, budgets are set, medical care is rationed, and the system takes care of institutions more than people." Without change, Medicare and Medicaid face the same fate, with long lines, lower quality, and higher taxes, he said.

Sec. Leavitt has been traveling the country, meeting so far with governors and legislators in 40 states to help them shape their own reform plans. He described a vision of a system in which everyone has access to "basic" insurance, with subsidies for those who need help in purchasing policies.

Roll Call Editor Mort Kondracke said after the speech that it was the first time he had heard a conservative vision of universal coverage so well articulated on an issue that he says has been owned by the Democrats.