If there is one thing Americans of all political persuasions can agree upon, it is that our nation's health care system is broken. Despite spending $1.8 trillion - 15 percent of our national wealth, and more per citizen than any other nation - each year on health care, what do we have to show for it? Not universal coverage. Not longer life spans. Not lower infant mortality. And certainly not better health than most other developed nations.

As bad as things look now, on the horizon a perfect storm is brewing. An economic disaster looms. But it is not unavoidable.

Begin by understanding that the U.S. health care finance system consists of two large sectors. The larger is employment-based coverage, serving most of the employed and some of their families. Almost as large is government financed coverage for the elderly, the long-term disabled, Native Americans, and many of the poor through Medicare, Medicaid, the Indian Health Service and the State Child Health Insurance Program. Some people buy health insurance on their own, but not many.

Employment-based health coverage is rapidly becoming more expensive for companies and for workers. Across corporate America, companies still providing health coverage are passing larger shares of these costs onto workers, reducing benefits and eliminating coverage for family members. Larger shares of the cost of health care premiums for workers are also being passed onto consumers, in the form of higher prices for goods and services.

Today, an estimated 45 million Americans are without health insurance, and the ranks of the uninsured are swelling by about 100,000 each month. Millions more are struggling to pay premiums that year after year are growing much faster than wages, while seeing their benefits shrink.

Contrary to public myth, the uninsured usually do not have only themselves to blame. Eighty percent of the uninsured are either employed - usually at agricultural, retail and service jobs - or dependents of those who are employed. For many of the working poor, with incomes barely too great to qualify for Medicaid, health insurance is a luxury sacrificed to pay for housing, food and transportation.

Here in Lane County, nearly one in five residents had no health insurance in 2004, and many more were underinsured. Statewide, the number of people without health insurance now stands at 17 percent. A majority of 1,200 respondents to the recent United Way Community Needs and Assets survey ranked the inability to pay for health care as the most severe problem they are facing.

While many Americans still have access to the best medical care and the most sophisticated diagnostic tools in the world, these growing numbers of uninsured and underinsured are left to overcrowded and expensive emergency rooms, free clinics - or they get no health care at all. Health problems are left to fester untreated until they reach the crisis level, and the expensive medical care that results is passed on to the rest of society to the tune of an estimated $35 billion to $65 billion annually, and rising.

To all of this add a realization that our rapidly aging population means tens of millions of new retirees will enroll in Medicare over the next 15 years. At the current pace, within 35 years Medicare and Medicaid together are estimated to become nearly as large as all of the federal government today. Assuming naively no growth in other government programs, funding Medicare and Medicaid at their current benefit levels will require a doubling of federal taxes. The American public will have little appetite for such an increase.

Put simply, America's health system is in crisis, leaving out too many and costing too much. Unless major corrective action is taken, things are only going to get worse.

Projected increases in health care spending are so large ...