Health care system is in need of some remedies.

Political pressure to reform health care is coming not only from workers who lack health insurance but also from employers squeezed by the costs of providing it. Big companies say escalating health care costs are hurting their ability to compete around the world. Small businesses say coverage has become increasingly expensive and unreliable.

One idea sounds promising: allowing small businesses to form purchasing cooperatives across state lines. That would give small businesses some of the advantages large companies have when providing health care coverage to workers. But it would require regulatory changes opposed by some states and consumer groups. The prospects for enactment aren't clear.

Any proposal that provides health care coverage for more people is sure to be expensive for the government. And efforts to control costs almost certainly will include the sort of steps that have made HMOs notoriously unpopular, such as limits on doctor visits and access to the latest health care technology.