This week, legislators in Harrisburg find health reform at the top of their agenda.

Our health system is huge and complicated and affects every one of us. Health care represented 16 percent of the national economy in 2005, a figure that is expected to increase to an astonishing 20 percent by 2016, according to a report from the journal Health Affairs. At least 2.2 million Pennsylvanians pay more than 10 percent of their family incomes on health care. Easing this burden must be a top priority for our legislators.

The General Assembly has made significant progress in recent years. It enacted Cover All Kids, making quality, affordable health insurance and preventive care available to every child in Pennsylvania. It passed legislation to reduce the frequency of hospital-acquired infections and expand the scope of responsibilities for nurse practitioners. It reduced the frequency of medical malpractice claims and the cost of such litigation. And it is making substantial progress toward the passage of a statewide smoking ban.

The next important step is to broaden participation by adults in our health insurance system. In Pennsylvania, nearly 800,000 adults under the age of 65 have no health insurance, including 109,000 here in Allegheny County.

It is well established that these individuals live sicker lives and, in some cases, die sooner than people with health coverage. The uninsured are less likely to have a regular source of care or to receive preventive services. They are more likely to delay or forego care for fear of high medical bills.

Most of us are just one major illness or accident away from joining the ranks of the uninsured. Most insured Pennsylvanians receive coverage through their workplace. Imagine a major illness or catastrophic accident such that you would no longer be able to hold your job and therefore would lose your employer-sponsored health insurance. COBRA would then be an option, but it is expensive and time-limited. You might try the individual insurance market, but it is likely you would be denied or have a difficult time finding an affordable plan. In other words, our broken health system affects all of us.

Small businesses are among those adversely affected. This problem is particularly acute here in Pennsylvania where our insurance laws have been written first and foremost to protect insurance companies. We are far behind most other states in creating a framework that seeks to stabilize high and unpredictable premiums in the small-group market.

We broadly support Cover All Pennsylvanians, a component of the Prescription for Pennsylvania, as a critical first step toward expanding access to quality, affordable coverage to the uninsured and to people in the adultBasic program. This public-private plan also would make a quality insurance product available to small businesses (those with fewer than 50 employees) at an affordable cost.

Among the results of such an insurance expansion: Those currently without coverage and small business employees would gain access to preventive services and, in the event of chronic conditions, physician management of their care. Further, adding more people to the risk pool, including small business employees who are anticipated to be healthier than the uninsured and people on adultBasic, would slow the rise in the costs of medical care and in insurance premiums.

There will be alternative approaches before the Legislature this week under the label of "consumer-driven health care." As consumer health advocates, we support individual responsibility and encourage consumers to be proactive participants in their own health care. However, some proposals described as "consumer-driven" -- specifically high-deductible health plans and health savings accounts -- would not benefit most consumers.

These plans work well for people who are healthy, but not for people with chronic disease, disability or illness. Yes, they would offer protection against catastrophic medical bills, but for families feeling the pinch of the current economic recession, they would offer too little help with prescription drugs, acute care and diagnostic procedures.

Our preference is clear. Cover All Pennsylvanians is a critical step forward and offers protection for those at greatest risk -- both small businesses and the uninsured. This public-private solution, especially if extended to reach nearly all adults, could help us avoid catastrophic illnesses while providing access to medical care if we become seriously ill.

Most importantly, it encompasses our values: All Pennsylvanians would have access to health care via high-quality, affordable health insurance; escalating health-care costs and premiums would be controlled, and everyone would contribute to the cost of care.

Our health system cannot be fixed with a Band-Aid approach; we need comprehensive reform. Our legislators should approve Cover All Pennsylvanians.