By JOHN BREAUX

It has become something of a cliche to say that America’s health care system is in crisis. But crisis is altogether the right word.

Last year alone, Americans saw health care costs go up nearly 13 percent, the largest increase in a decade for those with employer-sponsored health insurance. Meanwhile, the number of small businesses offering health insurance continues to decline.

Many employees now pay a greater share of their rising health-care costs, while employers offer less coverage with fewer options due to the increased costs they face. And critical public health-care programs, like Medicaid and Medicare, are under great financial strain, not to mention woefully unprepared for the onslaught of retiring baby-boomers.

I believe that for the first time in nearly a decade, this convergence of dire circumstances poses a challenge to revisit comprehensive health-care reform, a notion practically abandoned since reform was last seriously attempted in the early 1990s.

Americans fortunate enough to have health insurance today probably fall into one of several haphazard boxes – Medicare for the elderly, Medicaid for the poor of disabled, CHIPs for children, the Veterans Administration for military veterans, or an employee-sponsored insurance plan.

This outdated system of health-care boxes still leave 41 million Americans – one in seven – in no box with no insurance, yet taken together costs nearly $1.4 trillion annually. Isolated reform can do little to stop this crisis. The incremental approaches of the past decade have neither reduced the number of un insured nor prevented sharp rises in costs for premium payments, doctor’s visits, and prescription drugs for the millions of Americans with coverage.

When it comes to health care, a social contract exists in this country, but it is a decidedly inequitable one. Any citizen in need of care can walk into an emergency room and receive treatment. These unnecessary emergency room visits are expensive – costing up to $35 billion a year – and inefficient, leaving hospitals with unpaid expenses, and invariably result in higher costs for those with health insurance. But even worse, it is not the best type of health care for those in need.

The time has come to rethink our health-care system. Any new system must have at its core a new social contract that requires government and individuals to share equal responsibility for universal coverage. The solution is not a government-run system or a fend-for-yourself marketplace but, instead, a new approach that combines the best care options offered by the private sector backed by the resources and oversight of federal and state governments.

Indeed, this is the type of solution I unveiled in January with two speeches in Washington. The following guidelines, if followed, will provide a framework to achieve a new, universal health-care system.

Individual Responsibility: For the first time, all Americans will be responsible and held accountable for purchasing a basic level of health insurance. All Americans will have, at a minimum, a basic government package, defined by the federal government and similar to the standard benefit packages available to federal employees. Lower-income Americans will have their health-care costs subsidized by the federal government.

Guaranteed Access to Group Health Insurance: For the first time, all Americans will be guaranteed access to group rate insurance, similar to the Federal Employee Health Benefit Program, where federal employees are pooled together, and the government negotiates the lowest-possible premiums and offers a menu of health-care options.

Federal grants will be made available to help states create “Universal Coverage Pools” through which all state residents can access group coverage. Because of unique insurance markets and laws, states may have one pool, several regional pools, or even join a neighboring state to organize these purchasing pools.

Government Responsibility: Low and middle-income Americans will have their premiums partially or fully subsidized through a new, refundable, advancable tax credit, which states may supplement. Individuals may use their tax credit to purchase health insurance wherever they choose.

One of several supplemental packages defined by the federal government will be a “child wellness” benefit package, similar to current Medicaid benefits. Children whose families qualify for a “child wellness” benefit package subsidy.

Ensuring Medicaid for Vulnerable Populations: Medicaid will continue in its current form as a program for the elderly, disabled and long-term care patients. However, others eligible for Medicaid will transition into the new system. Our long-term care system also cries out for reform to accommodate the baby boomers, including consideration of long-term care tax credits, and more home and community-based care.

Providing a Valued Role for Employers: Employers, as well as states, are struggling with health-care costs and will not be asked to shoulder additional financial burdens. But, as key players in our current system, I will work with employers and states to develop an appropriate way to maintain current spending levels. The preferential tax treatment will continue for employers who offer health insurance, though I anticipate many employers, particularly small businesses, will opt into the new system.

Reforming the system of boxes and moving toward a less arbitrary, more uniform system of health care will prevent millions from being boxed out from the care they need. Our health-care system is as outdated as our health-care technology is innovative.

This crisis in health care is a serious challenge that President Bush and Congress must face in coming years. The collapse of our health-care system and the crisis of the uninsured have implications that transcend generations, and impact the health and security of all Americans. Recent attempts to reform health care have done little to reduce the swelling ranks of the uninsured and the vulnerable.

We must work to thrust universal coverage back into our national dialogue and collaborate to achieve universal health coverage in this country.

JOHN BREAUX represents Louisiana in the United States Senate.