For an ever increasing number of Americans, the promise of health security is slipping away and they are unhappy about it and demanding change. Perhaps that is why the politicians from Massachusetts to California to Pennsylvania are rushing out proposals promising "universal healthcare," which, sadly, offer very little that will actually reform our collapsing system, stem rising costs or improve care for patients.

Daniel Marsula, Post-Gazette Related coverage Rendell's Rx A promising prescription for Pennsylvania Rendell takes a wrong turn A bigger role for nurse practitioners Previous coverage From the Jan. 21 Forum: Rendell's remedy / Sandra Fox Rendell's remedy / Andrea R. Fox and Jessica Seabury

Crumbling health security is not simply seen in the steadily rising numbers of Americans without health insurance: now at 48 million and climbing. Every two weeks, Americans are seeing gaping, and growing, holes in their hard earned paychecks to co-pay for their and their families' medical expenses. Many Pennsylvania employers now force employees to pay up to $300 per month for family health insurance.

And that is only the beginning of the costs to employees. In the last five years, employers have jacked up the costs for prescription drugs where many employees now must pay $50, $75 or more for many prescriptions. In addition to ballooning co-payments for physician visits, many are even required to pay out of pocket for diagnostic X-ray and laboratory work.

At the same time that Americans are paying an ever escalating amount of money for health care, the quality of such care is deteriorating before our eyes. Hospitals are directing more and more resources away from direct patient care and into the pockets of executives and advertising agencies to chase the dwindling number of "consumers" with good health coverage, while doing precious little to prevent illness in the first place. While study after study has concluded that having good nurse-to-patient ratios is the most cost effective way to provide care, prevent medical errors and reduce hospital-acquired infections, many hospitals throughout Pennsylvania continue to subject patients to unnecessary risks through poor nurse staffing.

No question, our health care system is very expensive for those who pay for it, (both employers and employees) yet we don't get nearly the results in positive health outcomes as countries that spend far less for the care of their citizens.

This seeming contradiction is reconciled by the presence of our vast, private health-care bureaucracy -- a bloated monstrosity that squanders hundreds of billions of dollars every year on administrative overhead, windfall profits and outrageous executive compensation. The next time you see a health-insurance commercial, hear a radio ad, look at a billboard or gasp at the levels of executive compensation, think about the health-care deduction that comes out of your check every two weeks.

		Bill Cruice is executive director of the Pennsylvania Association of Staff Nurses and Allied Professionals, a union of 5,000 registered nurses and other health-care professionals (BillCruice@aol.com).

While these private insurers take up to 30 cents of every health-care dollar for such overhead, marketing and profit, by contrast, Medicare spends 3 cents, leaving 97 cents to spend on actual patient care.

Our health-care system is collapsing before our eyes and we have reached a critical point in the debate to fix it. Gov. Ed Rendell should be applauded for introducing innovative proposals and making the health-care crisis a policy priority. However, nothing in his proposals tackles the 800-pound gorilla that must be wrestled to the ground: the insurance industry and its vast, private bureaucracy that squanders our health-care resources. Health reform that fails to address this central malfunction of our system is akin to applying a fresh paint job to a collapsing house.

It is time to win real health security in America by establishing an improved Medicare for all Americans. Such a single-payer system will benefit every American as well as position our employers to compete more effectively with companies from countries with universal health care. A single-payer system such as Medicare would require employers to stop paying outrageous amounts of money to insurance companies and instead pay a smaller amount into a publicly funded agency, such as Medicare. While employees would also pay modestly into the system, such amounts would be substantially less than what the vast majority of employees are paying now under the current system.

With the massive savings generated by taking out the private health-care bureaucracy, our nation would be able to provide permanent health security to every American, restore our now disappearing right to go to any hospital or physician, improve patient outcomes, drastically lower the cost of prescription drugs and provide for long-term care.