Every week I take care of patients from southwestern Pennsylvania whose care has been delayed, and whose condition has worsened, because they lack health insurance. When they can't see a physician with a small problem, they wait until it becomes a big one. Patients delay care until their enlarging abscess (a pocket of pus and infection) becomes unbearable, or the cancerous growth in their mouth or throat starts to block their airway.

Bill Wood is a resident physician in otolaryngology at UPMC and a member of Physicians for a National Health Program (billwoodnc@yahoo.com).

Statistics recently released by the U.S. Census Bureau on the number of uninsured provide a sobering reminder of the failures of the U.S. health-care system. Here in Pennsylvania the number of uninsured has risen to 1.3 million: nearly one of 10 residents lacks coverage. Even for those lucky enough to be insured, ever-skimpier private policies helped push an estimated 29,000 Pennsylvania families into medical bankruptcy in 2004.

As physicians who face our state's health-care crisis day in and day out, members of Physicians for a National Health Program support a single-payer "Medicare-for-all" system for Pennsylvania and for the nation. Nearly everyone, regardless of ideology, agrees that establishing universal coverage is necessary. The most important question is "how."

Not all proposals are created equal. Because our current nonsystem is based on insurance companies whose natural market behavior is to compete to cover healthy people while shunning the sick, proposals that preserve our reliance on them are destined for failure:

"Individual mandates," like the much-celebrated Massachusetts plan, simply force the poor and near-poor to buy overpriced polices that offer grossly inadequate coverage, guaranteeing an epidemic of medical bankruptcies.

Reforms that force employers to contribute more for coverage just encourage them to cut jobs, wages or other benefits.

"Consumer-directed" health plans are nothing but a euphemism for substandard coverage, offering families no protection in the event of medical need.

Other countries have figured out how to provide higher-quality coverage to all their citizens for far less than we spend. Recent studies have detailed how the British and Canadians have lower rates of nearly every chronic disease and enjoy superior access to care. An exhaustive 2004 study of 21 international health quality indicators in five countries found that, despite double the outlay on health care, the United States performed noticeably better on only two.

How can we spend so much more and get so much less? Anyone who has dealt with the nightmarish paperwork of giant insurance companies already knows the answer: It's our reliance on private insurers.

Insurance companies stay profitable by keeping those who actually need health care from getting it. To do this, they erect a giant, expensive bureaucracy whose only purpose is to fight claims, issue denials and screen out the sick. They consume care dollars, but their main output is paperwork headaches.

This affects everybody: doctors and hospitals must maintain costly staffs just to deal with insurance hassles, and businesses are saddled with the burden of administering their own health benefits. In total, this administrative waste consumes nearly one-third of our health spending.

Research has shown that streamlining payment though a single public payer could save the United States more than $350 billion per year. Such a system could have saved Pennsylvania $14 billion in 2003. That's more than $12,500 per uninsured resident, enough to provide high-quality coverage to everyone.

Everybody would be covered for all medically necessary services, including doctor, hospital, long-term, mental health, dental and vision care. All prescription drugs would be covered. Patients would have free choice of doctor and hospital, and physicians would be unleashed from corporate dictates over patient care.

In the United States, opponents resort to cries of "socialized medicine," but don't be fooled. In a "socialized" system (like the U.S. Department of Veterans Affairs or Defense Department systems), the government employs the doctors and owns the hospitals. In a single-payer system, they stay private.

Similarly, much hysteria has been printed about alleged "rationing" of care in other nations. The truth is that the United States rations care more harshly than any other industrialized country.

According to the Institute of Medicine's most conservative data, 18,000 Americans die every year due to lack of insurance. Millions more go without needed care due to cost. Now that's rationing.

What's more, under their national health-care system, Canadians don't even wait very long for care. The median wait time for nonemergency, elective surgery was four weeks in 2005. Service was so fast that in a recent survey only 3.5 percent of Canadians reported feeling they had waited too long for care. Since we spend twice what they do, a U.S. system should be able to eliminate waits entirely.

Single-payer offers the only real solution for Pennsylvania and for our nation. It's time for politicians to stand up to the insurance giants -- as they have in California -- in the interest of the public.