Doctor-in-chief will see you soon?

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Now that California's attempt at state-run universal health care has fizzled and Massachusetts groans under the doubling cost of its Commonwealth Care, activists find fresh hope in the federal government's infinite capacity to deficit spend. Made-in-Washington health care is suddenly in vogue again and ideas are flying.

What's uncertain is which bad idea will get traction. It could be Sen. Hillary Clinton's old, all-government-all-the-time proposal, or the plan to throw open Medicare to everybody, or something worse.

In recent years, the congressional Democrats' ideas for health care constituted a collection of slogans. Now they run Congress, but as the thoroughly politicized debate over children's health insurance just demonstrated, their agenda still hasn't progressed beyond the bumper sticker stage yet. If nothing changes, the Democrats seem set to simply waste this year chanting, "10 million more children" and "let's hate Bush" instead of going to work.

So it looks like it's up to us, and Republicans' very first job is to know where we stand. This is where I stand:

• Affordability: Let's find new ways to expand opportunities for working people to buy their own insurance. If reducing people's taxes to help them pay does the trick, we should cut taxes and give them the largest possible incentive to insure themselves and their families. Perhaps the federal government could also subsidize premiums for low-income families.

• Consumer-driven care/individual choices: I don't want federal bureaucrats or regulations picking my doctor, or scheduling my surgery, or deciding what prescriptions I can have. Who does? People should be empowered to choose the care the best fits their needs, period.

• Transparency: Informed consumers make rational, cost-effective choices, but to do so they need real price information and quality rankings. Even the most attentive patient can't be expected to understand that $100 "mucus recovery system" listed on the hospital bill is a box of Kleenex. Let's stop the nonsense.

• Safety: No one has the right to deliver Third World care and pretend it's tolerable, or even less costly. This is about basics, like hand-washing. Hospital patients have a right to be treated with clean hands when we know that washing can prevent a statistically significant portion of the 1.7 million hospital infections that kill 99,000 patients each year. It's an area where government can help directly by setting standards and enforcing them, and by publicizing the failures so patients will know the facts and act accordingly.

• Technology and innovation: The world is in the Internet age, but health information technology is stuck in the age of the file folder and typewriter. The systems that already do everything from manage nuclear power plants to order pizza online will save money and lives when finally applied to health records.

These ideas aren't final answers. In fact, a Republican task force within my own committee is assembling proposals which should make sense to working people and can attract wide support among all Americans. I hope my friends in the other party will do some thinking, too. Bipartisan cooperation on health care could break out in Washington, D.C. Now, that would be real change.

Joe Barton, Texas Republican, is ranking member of the House Energy and Commerce Committee.