Seven months after ending his abbreviated presidential bid, Pittsburgh native Tom Vilsack was back in town yesterday as an evangelist for U.S. health-care reform and universal insurance coverage.

"This system has to be available to everybody," he said during a speech at Allegheny General Hospital on the North Side.

The two-time governor of Iowa is now an adviser to Democratic frontrunner Sen. Hillary Clinton, who unveiled her health-care plan earlier this month as the issue continues to gain importance in the campaign.

There are "moral reasons," Mr. Vilsack said yesterday, for a more efficient, more egalitarian system, as well as political and economic ramifications. Medicare, the government-sponsored health insurance program for people ages 65 or older, remains burdened with at least $57 trillion in unfunded liabilities. If the country does not grapple with those obligations, one-half of the federal budget soon will be consumed by Medicare, he said, while the other half will absorb the national debt, leaving little for anything else.

Beyond the federal government, he sees other problems: insurers avoiding risk, hospitals focusing on quantity over quality and the young not contributing their "fair share" of costs.

"My vision," he said, is a brand of consumer- and patient-centered health care that is available to every American -- the "right care at the right time in the right way."

The fact that certain states such as Pennsylvania are providing consumers with more information about infection rates and hospital performance is a good step, he said. But providers also need to spend more on prevention as a way of avoiding larger costs down the line. The system "provides absolutely no incentive for prevention," he said.

"It's not just about how long you live; it is how well you live."

Another issue bothering Mr. Vilsack is the plight of African Americans, who receive inferior care under the current system, he said. And from state to state, there are great disparities in chronic disease management, If all states performed to the highest quality standards, the country would save 20,000 lives, eliminate 23 million sick days per year and free up $4 billion for research and development, he said. If electronic record keeping were more widespread, it would save another $77 billion a year, he said.

"Quality is a money saver and a life saver."