Written by Larry Sobal, CEO, Appleton Cardiology Associates

As a 20-year resident, I've grown proud of Wisconsin's quirky reputation as the land of cheese, football, summer festivals and Northwoods recreation. What I did not expect is that our fair state may soon compete for the national spotlight as a result of our thinking regarding health care reform.

Health care has been a contentious issue in many states but especially here in Wisconsin, where premiums are the third highest in the nation (26 percent above the U.S. average). Moreover, premiums are rising much faster in Wisconsin than nationally (9.3 percent versus 6.1 percent in 2006) and employee-paid portions of premiums have been climbing more four times faster than wages while employers are implementing more aggressive health plans (if they offer insurance at all).

It's no wonder that there is a lot of talk about overhauling health care by governors and presidential candidates alike. Following the lead of other state-specific attempts at health care reform, most notably in Massachusetts, it's not surprising that Wisconsin joined the fray with its own ideas.

Within our state there are currently some aggressive proposals for comprehensive reform that vary in substance while containing similar principles of establishing a risk pool of the state's entire work force and their families.

First is the Wisconsin Health Plan, chiefly associated with former state budget director David Riemer, a moderate Democrat, which aims at rewarding insurers who combine networks of high-quality providers with a reasonable cost. While the most "market-oriented" — including a small-scale health savings account feature — it would automatically enroll every Wisconsin resident for health care coverage.

Second is the Wisconsin Health Security Plan, which applies many aspects of the Canadian single-payer model to Wisconsin, most notably the replacement of 450 private insurers with one public entity to replace private insurers. It would be funded by payroll taxes on both employers and workers.

Third is the Wisconsin Health Care Partnership Plan, which hopes to build on employers' familiarity with the state's Workers Compensation program, the first in the nation, and imposes a fee on all employers to cover the care and income of injured workers. Devised by state AFL-CIO President David Newby, the plan also includes a mechanism for a unitary fund to handle claims, thereby cutting out the costs imposed by private insurance bureaucracies.

Not to be outdone, the state Republicans have put forth a "Smart Medicine" proposal focused on high-deductible health savings accounts.

Alongside this progressive thinking is Gov. Jim Doyle's latest budget proposal, which proposes to expand the state's coverage of low-income families so that about 98 percent of Wisconsinites would have health coverage (about 600,000 are now uninsured). Doyle's proposal would consolidate all existing programs for low-income people (chiefly Medicaid and the S-CHIP program for children and parents) and expand them to childless adults, to be funded by a combination of higher tobacco taxes, a new hospital tax, and $60 million in new federal funding.

However, Doyle's plan is potentially threatened by President Bush's recent policy that imposes new standards on states that use federal money to provide health insurance to children whose families have incomes of more than 250 percent of the federal poverty level.

The first proposal, Healthy Wisconsin, has received the most attention, as it is one of the most sweeping health care reform proposals in the country. Both the Milwaukee Journal-Sentinel and Wall Street Journal have noted its aggressive (some say ridiculous) design and tax impact.

For now, this is all just interesting conjecture. Since Massachusetts actually implemented their own grand experiment in universal health care effective July 1, and California is actively considering a similar program along with Connecticut, Illinois and Pennsylvania, Wisconsin is not at center stage — yet.