Sens. Hillary Clinton and Barack Obama are proposing to increase government involvement in health care. Many Americans wonder if this is a good or bad idea.

After nine years practicing psychiatry in Pittsburgh, I spent last year working in Australia, a country with universal Medicare. That experience has convinced me that from the standpoint of both physician and patient, universal Medicare is the way to go.

Some Americans believe that countries like Australia, Canada and nearly all of Europe have "socialized medicine." For many, it's a vague concept that often conjures images of uncaring doctors, dirty government clinics, cracked plaster, crowded waiting rooms and really old magazines. And if you don't like it -- well, you can't fight city hall.

But that's just a dark fantasy. Australia has attractive offices and hospitals, great doctors, state-of-the-art care and, most importantly, quick and easy access to high-quality emergency care.

It's not socialized medicine, it's Medicare for all. You are born with it, you die with it and you get all the care you need in-between. Everyone has insurance, all the time.

Because of this, there is a booming private sector in Australian medicine. A physician can hang out a shingle in any neighborhood and turn a profit by providing quality care. Everyone can choose a family doctor and see specialists as needed.

Here are a few situations I have encountered practicing medicine in America that would be impossible in Australia:

• A relapsed alcoholic cannot return to rehab after a DUI conviction because of a $5,000 debt for previous care.

• An insured, suicidal patient has used up all 30 days of inpatient coverage for psychiatric services and says he cannot live with having bankrupted his family, who must pay more than $1,000 per day for care.

• A young, intelligent, brain-injured patient is denied expensive rehabilitation because of a lack of insurance and instead is sent for years to a nursing home for the indigent aged, most of whom are demented.

In 2007 the Commonwealth Fund, a health-care policy think tank, ranked the medical systems of Australia, Canada, Germany, New Zealand, the United Kingdom and the United States, using measures that included access to care, patient safety, efficiency of care and equity. The United States scored well on only one measure, preventive care, but very poorly on providing access to it. It was dead last on everything else.

Americans were more likely to have to visit an emergency room to get care for a condition that could have been treated in a physician's office. They were less likely to get a prompt appointment with their doctors and to have easy access to care on nights and weekends. They were much more likely to report that they never received recommended medications, procedures or other treatments. Not surprisingly, the United States had much higher death rates from conditions that would have been amenable to medical care.

A 2007 Consumer Reports study found that 16 percent of Americans were uninsured and that 29 percent of Americans who did have insurance were underinsured.

The lack of coverage in psychiatry, my own field, is a particular problem. For example, in March, the Pennsylvania House gave preliminary approval to the "Pennsylvania Access to Basic Care" program. Designed to give hundreds of thousands of uninsured working adults access to health care, the program still would fail to provide for full psychiatric coverage. The Senate has not yet acted on the legislation.

While Americans drain their bank accounts to pay for necessary health services, Australia manages to spend less than half of what we do on universal medical care that is almost completely free from out-of-pocket expenses. The United States spent $6,102 per capita on medical care in 2004, with only 86 percent of us covered by health insurance. Australia spent $2,876 per capita to provide medical care to every citizen.

The universal Medicare program in Australia saves money by eliminating overhead and by providing reimbursement only for care that has been proven to work. The program provides disincentives for unnecessary medications or procedures and allows physicians more time to accurately diagnose and monitor patients. It offers "pay for performance" incentives to physicians who do the best job of curing and treating chronic diseases. Contrast that with the "pay for denial of care" system of so many U.S. insurers.

I found in my Australian practice a refreshing absence of the anger, bitterness and disgust that pervades our Alice-in-Wonderland bureaucratic nightmare of a medical system.

The Australian system works because the Australian people all have a stake in it and they vote. They demand higher quality care than we do, and they provide it for themselves through their government.

Americans should realize that we can do the same, and we should demand that our presidential candidates promise to make it happen.