(07-26) 04:00 PDT Washington -- Rep. Pete Stark of Fremont, who would play a key role in the national health care debate if Democrats take control of the House in November, announced a plan Tuesday for universal medical insurance for all Americans.

Stark, the ranking Democrat on the House Ways and Means health subcommittee, offered a plan that is based on Medicare's payment rates and low-cost administrative structure and a requirement that employers provide coverage for all their workers, even part-timers.

By offering his far-reaching plan, Stark laid down a marker, letting it be known that he and other advocates of the long-debated idea of universal medical insurance will be key players if Democrats get back the House control they lost in 1994, just as then-President Bill Clinton's sweeping health care proposals went down in flames.

His plan goes much further than those offered by other Democrats. For instance, New York Sen. Hillary Clinton has endorsed a plan calling for all children to be covered by medical insurance. She also supports a plan to lower medical costs by adopting electronic patient records that, it is estimated, would cut costs by reducing paperwork and the need for duplicative medical tests.

Like Clinton, Sen. Russ Feingold, D-Wis., is thinking of running for president in 2008. He has introduced legislation to create pilot projects to help states move toward universal coverage.

The House Democratic leadership's "New Direction for America'' platform for the November election calls for giving Medicare the right to negotiate discounts with drug companies for the new prescription drug benefit and supports stem cell research.

Republicans, in the main, fiercely oppose the type of system Stark proposed.

In addition to trumpeting the Medicare drug benefit for seniors passed in late 2003, the Republican Congress and President Bush have set up so-called tax-free health savings accounts that people can use to save for future medical expenses. They are also trying to give small businesses tax breaks for buying medical coverage for workers.

And they want to rein in lawsuits against doctors, hospitals and drugmakers, which they say are responsible for fueling the steady increases in health care costs.

Stark and his supporters say all these ideas are just small fixes for a huge problem.

"The question is whether society will provide coverage for everyone or for just a wealthy few,'' Stark said in announcing his AmeriCare Health Care Act.

"Everyone should benefit from this bill, with the exception of the bankruptcy bar and collection agencies,'' said Stark, referring to families who have been driven into financial despair by uninsured medical expenses.

His program would be financed by contributions from employers, individuals and states, which would kick in to cover their poor residents. Stark said premiums would be kept affordable by using Medicare's administrative structure and getting discounts through the program's mass numbers.

There would be no "single payer,'' a sole government agency providing medical care. Instead, people could keep their current coverage and doctors under Stark's plan.

It is estimated that at the outset it would cost the federal government $50 billion to $60 billion a year to get the program running. But advocates estimate that over time, savings would kick in. Money would also be saved by cutting the medical bills of the uninsured, who frequently wait until a problem is serious and harder to treat -- and thus more expensive -- before seeking medical care.

Over time, employers' costs of insuring workers and their families would actually drop, Stark said.

Such claims won't sit well with many in the business community, which, since President Harry Truman first proposed it in the late 1940s, has consistently lobbied against national medical insurance as a job killer and a tax raiser.

Stark's proposal was endorsed by the ALF-CIO, Consumers Union and the American Pediatrics Association. The California Medical Association's president, Dr. Michael Sexton, appeared with Stark but stopped short of a full endorsement.

"This bill has many of the elements we feel are fundamental to where we need to be,'' Sexton said.

In California, discussion about how to provide coverage for the 6 million residents without medical insurance -- part of the 45 million Americans who lack coverage -- is emerging as an issue in the governor's race. Gov. Arnold Schwarzenegger held a three-hour roundtable on the issue Monday in Los Angeles and heard a wide variety of views. He said afterward that he isn't ready to endorse a particular approach.

His Democratic opponent, state Treasurer Phil Angelides, criticized the governor as an election-year convert to the need to expand coverage.

E-mail Edward Epstein at eepstein@sfchronicle.com.

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