One of Sicko's most memorable scenes is a take-off on the opening credits from Star Wars, when a seemingly endless list of ailments that private insurance companies won't cover scrolls across the movie screen.

"The Star Wars scene was absolutely hilarious," says Wyden, who saw Sicko shortly after it opened. "Those days are over under the Healthy Americans Act."

The relegation of uncovered ailments to a galaxy far, far away will happen because insurance companies will be forced to sell new kinds of products that won't exclude people based on pre-existing conditions, age or other factors, Wyden says of his proposal. He's optimistic of political success because his plan builds on two things Democrats and Republicans want, health coverage for everybody and private-sector control, respectively.

But physicians who argue for single-payer systems like those featured in Moore's movie say Wyden misses the point, because private insurance plans are fundamentally flawed and need to be abandoned. Neither Republicans nor Democrats are willing to do that, however, because the health insurance industry wields too much power in Congress, critics say.

Wyden says Measure 23's overwhelming failure at the ballot box in 2002 is evidence that Oregonians don't want a single-payer system. Meantime, supporters of the doomed measure say its failure is proof that insurance companies (which helped outspend proponents 10 to 1) can spike any threat to their business enterprise.

If the enemy of the good is the perfect, political compromise will almost certainly be necessary in Congress, regardless of who wins the 2008 presidential election. But it's less clear whether Wyden can collect the votes to pass his proposal. It's also hard to see how any negotiated compromise with a realistic chance of passing will reduce costs and improve health care for the Oregonians who must now travel to India to find the care they cannot afford here.

"It's not realistic if it's not going to work," says Dr. Frederick Goodrich, a retired obstetrician-gynecologist who is an Oregon member of Physicians for a National Health Program. "It's very unrealistic." —