"We are getting close to having a conversation on what needs to be done about health care, in part because people who have health security at the moment are less secure than they would like to be. People who have employer coverage are seeing it undermined."

National polls recently have indicated solid backing for guaranteed health insurance, even if it means raising taxes somewhat. Support evaporates, however, if it involves substantial tax increases or premium increases.

The panel's report follows Massachusetts' decision to cover all its uninsured residents by July 2007, through a mix of employer plans, government programs and a requirement that uninsured people purchase their own coverage if they can afford to do so.

The recommendations of the national panel, which will be completed after a comment period that ends Sept. 1, call for immediate and long-range changes.

In the near term, all Americans should have protection against catastrophic health care expenses, either through a government program or a private insurance plan, the panel recommended.

It also called for increased support for safety net health care providers, such as community health centers, and for a concerted effort to improve quality of care and information for patients. And it called for increasing access to hospice care for patients nearing death.

In the long term, by 2012, all Americans should have coverage for a core package of health care services, including preventive care, doctor visits, hospitalization and prescription drugs.

"This will require new revenues to provide some health care security for Americans who are now at great risk," said the panel's interim report. It listed income taxes, payroll taxes, business taxes, sales taxes and taxes on alcohol and tobacco as possible sources of revenue.

Members of the panel include doctors, nurses, a hospital administrator, advocates for patients and business representatives. Secretary of Health and Human Services Michael Leavitt is also a member, but he took no position on the recommendations.

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