While comprehensive health care reform seemingly remains a distant dream, Congress is working on some incremental steps that could save lives and improve insurance coverage.

Three overriding problems beset the health system: a rising tide of uninsured Americans, probably numbering 50 million; a quality care/medical errors crisis that kills up to 90,000 people a year; and exploding health costs.

[IMGCAP(1)]Last week, for example, a Harvard University study showed wide variations between hospitals in various cities in the treatment of heart diseases and pneumonia, ranging from 95 percent effective in Boston to 60 percent or less in some cities in California.

Another study showed that nearly 12,000 patients in Pennsylvania hospitals contracted infections, costing $2 billion for treatment and causing at least 1,500 preventable deaths.

Medical errors are ripe targets for lawsuits, which raise insurance costs, drive doctors out of business and inhibit free discussion among professionals about needed improvements.

While Republicans want to cap medical malpractice awards — the House is due to vote next week on another bill to do so — Democrats are adamantly opposed, partly out of loyalty to the trial lawyer lobby, which leads them to regularly block such legislation in the Senate.

However, last week there was a partial breakthrough: House-Senate agreement on a bill to protect the content of future professional discussion of errors and “near-misses” from being used as evidence in lawsuits.

The agreement was worked out in an all-night negotiating session between aides to Sens. Mike Enzi (R-Wyo.) and Edward Kennedy (D-Mass.), chairman and ranking member the Senate Health, Education, Labor and Pensions Committee, and aides to Reps. Joe Barton (R-Texas) and John Dingell (D-Mich.), chairman and ranking member on the House Energy and Commerce Committee.

The resulting patient safety bill is scheduled for action in the House this week as part of its “health week” agenda.

In the meantime, for years, experts have said that one answer to the quality/medical errors crisis is information technology — making medical records and orders digital so they can be easily read and transferred to people who need them.

The health industry, though steeped in advanced technology for everything from artificial hips to brain implants to nuclear diagnostics, has trailed other industries like financial services and transportation in computerizing its records.

FedEx packages and bank records are easily traceable online, and people can buy stock and even renew driver’s licenses electronically. But 95 percent of doctors’ records are still filed on paper, even if their billing systems are computerized.

The computer industry is moving into the field energetically, offering a blazing array of hardware and software systems that are now creating a new problem: They can’t all talk to one another.

Health and Human Services Secretary Mike Leavitt likens the situation to the early days of railroading in America, when companies had different gauges of track, and freight and passengers had to transfer in mid-journey because locomotives and cars couldn’t continue.

Earlier this year, Leavitt appointed a commission to work out standards, and last week the Senate HELP Committee worked out bipartisan legislation to codify the HHS action and provide grants to hospitals to upgrade IT systems, establish quality measurement systems and create rewards for providers who improve the quality of care patients receive.

The legislation is a compromise between bills co-sponsored by Senate Majority Leader Bill Frist (R-Tenn.) and Sen. Hillary Rodham Clinton (D-N.Y.) and by Enzi and Kennedy.

Given some willingness to compromise on patient safety and IT, the ideal would be for Republicans and Democrats to work out an even larger agreement on medical malpractice — allowing caps on malpractice damages while going even further to insure quality care and encouraging states to de-license providers who habitually commit errors.

As part of “health week,” the House is also scheduled to take up measures to expand health insurance coverage and reduce costs, although the chances for bipartisan progress appear slim unless changes are made in the bills’ design.

One bill would authorize creation of “association health plans,” permitting businesses in the same industry to form insurance pools.

Another would allow individuals to shop for insurance across state lines. Both bills are hotly opposed by state insurance commissioners and many governors because they allow insurance companies to escape state regulation.

The AHP bill is opposed by Blue Cross-Blue Shield insurers who now write most small-business policies.

The opposition is likely to assure that, even if the bills pass the House, they are likely to die in the Senate. Their chances of passage — and of helping the uninsured — would improve if they were modified to allow for state regulation to guarantee the insurers’ financial solvency.

The House next week is not considering a GOP bill that would expand health savings accounts — a surprisingly fast-growing device to allow uninsured persons to buy high-deductible insurance policies and establish tax-exempt accounts to pay their medical bills.

According to a study by America’s Health Insurance Plans, the number of persons covered by HSAs more than doubled last year, up to more than 1 million, although that does not begin to dent the total number of the chronically uninsured, estimated at 20 million to 30 million. Fifty million is the estimated number of uninsured at some time during a year.

The GOP’s bill to expand HSAs would give tax credits to moderate-income persons and small businesses to establish HSAs and also make “catastrophic” insurance premiums deductible.

Republicans are convinced that HSAs will help reduce overall medical costs by requiring individuals to pay ordinary medical bills out-of-pocket and shop for the most economical care. Democrats traditionally oppose the plans as threatening to existing employer-based and government health plans.

The House is not considering the HSA bill now because of its cost — $125 billion over 10 years. The bill deserves passage, even if it is only a partial answer to the problems of cost and the uninsured. Congress isn’t ready to solve problems in a big way, but small steps are better than none.