Talk of universal health coverage all but died a decade ago, with the demise of President Clinton's national health-care initiative.

Lately, though, the health-care discussion has resurfaced.

Just last week, Massachusetts Sen. Edward Kennedy outlined a plan to cover the nation's 43.6 million uninsured. Earlier this month, the federal Institute of Medicine called for Congress to put national health care in place by 2010. In December, Dr. Kenneth Melani, head of the region's biggest health insurer and the nation's 11th largest, predicted that national coverage was all but inevitable. And former U.S. Treasury Secretary Paul O'Neill pitched his notion of universal coverage at a national conference on health-care improvement in New Orleans. Yesterday, a group of Pittsburghers joined the chorus.

More than 60 people met Downtown to form a grass-roots group to put national health-care coverage on the radar screen throughout the region and to bolster compatible efforts in Pennsylvania and in neighboring states.

Called to arms by some of Pittsburgh's veteran community activists, including Molly Rush, whose protest pedigree dates back two decades to the antinuclear activities of the Plowshares Eight, and Mike Stout, a United Steelworkers union member who crusaded against Mon Valley steel mill shutdowns in the 1980s, the coalition-in-the making brought out usual contingents of labor, clergy and politicians.

But also attending were a handful of doctors, some academics, an executive from the University of Pittsburgh Medical Center's health insurance subsidiary, a campaign representative for Democratic presidential candidate Dennis Kucinich and a number of people, from retail clerks to artists, who were there because they have no health insurance.

One of the last camp, Steve Donahue, who met Rush through the Thomas Merton Center, said he'd avoided doctor's visits for even rudimentary checkups for years because he lacked insurance coverage. Last year, after ending up in the hospital twice and falling behind on payments for the visits, he said he's been turned over to a collection agency.

Donahue said he refuses to sign up for the state subsidized AdultBasic health plan, citing not only a long waiting list, but also a belief that enrolling would only "perpetuate a bad system by participating in it." In his view, the program is just one of those designed to help only some of the uninsured. Those incremental efforts, he believes, inevitably dampen efforts to pass a plan that offers coverage to all. Charles Crystle, a Lancaster business owner who recently ended a Democratic primary bid to unseat U.S. Sen. Arlen Specter, R-Pa., said health care became a focus of his campaign after repeatedly seeing how the cost of coverage was hurting businesses as well as individuals across the Commonwealth.

"I've met with maybe 20 manufacturers across the state -- all Republicans -- and they're just getting killed" as premiums to cover their workers rise "20 percent or more year after year."

Crystle said premiums to ensure the employees at his software company now cost roughly $350 a month for individual coverage and more than $700 a month for family coverage.

Dr. Scott Tyson, who heads a South Hills pediatric practice with 11 doctors and three offices, said he thinks sentiment for national coverage is growing because "most people are one event that they can't control away from catastrophe."

Job loss shouldn't mean loss of health care coverage, he said.

Tyson acknowledged that support for national coverage has been scant among physicians over the years, but thinks more doctors might be supportive now, given the administrative burdens and paperwork that a complex insurance system has imposed on the practice of medicine.

Part of his contribution to the grass-roots group is trying to involve more of his peers in Physicians for a National Health Program, a Chicago-based organization that counts 10,000 members nationwide, including about 135 in Allegheny County, Tyson said.

Dan Fine, a retired physician, said he thought doctors were "increasingly realizing" that the current insurance system had pushed many of them from private practice to employment at large health care systems.

Numerous participants in the meeting said that a key mission of their fledgling organization would be to fight political and other interests that argue universal coverage would cost more than the nation can afford. The costs of administration involved in today's health insurance industry, which by some estimates equaled 10 percent or more of the $1.6 trillion spent on health care in the United States in 2002, would alone be enough to provide coverage for many of the nation's uninsured.

"I'm sick and tired of people saying we can't afford it," said state Sen. Jim Ferlo. "We're already paying for it."

Others also noted that other Western nations with national health insurance spend far less of their gross domestic products on health care than the United States, while providing coverage for all of their citizens.

Stout said he helped pull the group together because "everybody is having trouble" and "it's time for us to stop preaching to the converted."

His aim for yesterday's meeting was building a coalition that would take the call for universal health coverage "to the streets" and, ultimately, "to the [presidential nominating] conventions."

But coalition building, momentarily got stuck on some of the same issues that divide presidential contenders, business interests and others as they confront the prospect of national or universal coverage.

Several said they couldn't support any sort of private, for-profit insurance industry involvement or any of the "incrementalism" inherent in such proposals as the tax-credit approach that President Bush has promoted, most recently in his State of the Union address.

At the end of yesterday's brisk discussion on a brisk January day, Rush said a consensus emerged around a single-payer, tax-supported system that would provide coverage to all.

"As long as we can stick together on that, it's great," she said. "We don't have to get bothered over every little jot and tittle."

Not so for the presidential contenders or for other high-profile advocates of universal coverage.

Their thinking runs the gamut, from Kucinich, who advocates single-payer, tax-funded coverage to Paul O'Neill, who envisions a system where the employer-based health insurance coverage that has long prevailed in the United States be replaced by one in which everyone purchases catastrophic health coverage and pays out-of-pocket for basic care.

O'Neill in a recent interview was quick to point out that what is catastrophic to someone depends on his or her income. For low-income households, it might be a very small amount, with the rest picked up by tax-based funding.