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Oregon has examined the federal health reform, raised an eyebrow and said "We're going to do better, and do it without forcing people to buy private insurance." Of all the states, it may be in the best position to lead the way. Sen. Ron Wyden, who is pushing the White House to let Oregon head in a different direction, says the loathed "individual mandate" will be the first thing in the trash bin.

First, though, Oregon has to get a waiver from the White House allowing it to use federal health care funds right now for a system that isn't exactly what Congress passed. I expect there is plenty of insurance company lobbying pressure against the waiver, since Oregon's long health reform history indicates it will go for a broad, affordable public option--Medicare-style private health care without the insurance companies in the middle.

Oregon's state health plan dates back to 1989 and it has struggled to keep up coverage for the poor and working class, mostly because it had no extra federal funds for health care expansion--it just had to stretch the dollars already available using efficiency and comparative effectiveness of treatments. But its plan has survived, and now covers most children and many low-income adults with a mix of private and public options. The original plan also called for an employer mandate, but it failed for lack of a single federal waiver regarding employer-provided insurance.

This time around, Oregon's experience puts it in a position to succeed on a much broader scale, offering affordable health coverage without a requirement for individuals to buy private insurance. The state's biggest newspaper, the Oregonian, makes the case on its editorial page that a federal waiver would allow Oregon and some other states to do much more at lower cost than the federal plan.

That's a far cry from Florida's request for waivers from initial health regulations. There, state insurance commissioner Kevin McCarty wants to let private insurance companies keep gouging Floridians, spending less on health care and more on corporate overhead and profit. If you wonder who backed the Florida waiver request in state hearings, it was four insurance companies including Aetna and United Healthcare, and the lobbying group for the insurance brokers who currently skim off up to 20% of your premium.

Oregon and Florida are in opposite corners, even though both are asking to go their own way. You can bet that the insurance industry lobby won't be supporting Oregon's freedom as they did Florida's.