A system sick at heart.

Is health care a human right or a commodity offered to the highest bidder?

A MODEL OF PASTORAL COURAGE THROUGHOUT HIS LIFE, Chicago's Cardinal Joseph Bernardin embraced his final days with a grace and composure few who witnessed it will ever forget. Bernardin was able to meet his end with such dignity no doubt in part because he could be confident in a thorough and compassionate medical care--treatment he was acutely aware not all Americans could similarly rely upon.

Bernardin called health care "an essential safeguard of human life and dignity" and argued that it was a social obligation that every person have adequate health care. Inspired by his vision, Illinois legislators last year sponsored the "Bernardin Amendment," establishing health care as a fundamental human right and calling for universal coverage by 2002. In a small indication of public sentiment on the issue, the amendment was overwhelmingly approved by voters in a nonbinding referendum.

It remains to be seen if state legislators can live up to the ambition of the Bernardin Amendment. Meanwhile in the nation's capital, it appears unlikely that vision can be broadened across a national canvas. A few years ago the nation seemed on the verge of awakening to the health care crisis that is a daily reality for millions of Americans, but the fight for universal care became ensnarled in the national personality conflict with the Clinton family and was summarily dismissed.

Five years later, the prognosis for American health care has only deteriorated. In 1987, 15 percent of the populace--32 million Americans--went without health coverage. Now, after 10 years of unprecedented prosperity, 44.3 million people have no health coverage and perhaps 10 million more have spotty or simply inadequate coverage. Naturally it is the most vulnerable who are affected the worst. One third of families that earn less than $35,000 per year forego health insurance as they try to meet other basic needs. If current trends continue unchecked, over 20 percent of Americans will be without health insurance by 2005. How does this basic social problem persist during boom times in the world's wealthiest industrialized society?

Some clues are offered in a review of the players in Washington during the most recent bubble of activity on health care reform. While Republican leaders were literally wined and dined by health insurance companies, trial lawyers lobbied for "patients' rights" clauses, and Democrats courted America's physicians. Here then are the social visionaries hammering out our health care policy: insurance companies hoping for new inroads in cost-cutting patient care, trial lawyers viewing untapped vistas of class-action opportunity, and doctors finally inspired to join the debate to prevent their astonishing fees from facing any further reductions.

Who's missing from the negotiating table? Anybody unfortunate enough to be an unhealthy member of an HMO or the working poor who can't afford coverage at all.

Health care is a $1.1 trillion industry in the United States. Americans paid $4,090 per capita on health care in 1997--more than any other industrialized nation and almost twice as much as Canada's $2,095 and well above Germany, $2,339; Japan, $1,741; and the United Kingdom, $1,347. But for all that spending, we are the least satisfied with the treatment we receive. Twenty-five percent of Americans report difficulty getting care when needed. That compares to 21 percent in Canada, 19 percent in New Zealand, and 15 percent in Australia and the United Kingdom--all nations with some form of universal coverage.

In 1994 proposals for universal coverage succumbed to an onslaught of negative advertising that convinced Americans they didn't want their health held hostage by insensitive government bureaucrats. Thank goodness. Now, those of us fortunate enough to have some kind of coverage have our health held hostage by insensitive free-market bureaucrats in a private system locking out those most in need of treatment and maintained by incentives against care.

Candidates in the upcoming presidential election have begun to package proposals for a gradual expansion of the government's role in providing health care. What no candidate is likely to propose is a universal health care system that envisions medical care as a basic guarantor of human dignity, not as a social privilege divvied out to those who can ante up.

That's too bad. Cardinal Bernardin reminded Americans that adequate medical care is fundamental to human dignity. Pope John Paul II has repeatedly warned that the amoral currents of the free market historically fail to respond adequately to all social needs. As long as we continue to treat health care as a market commodity instead of a basic human right, our health care system can only remain, well, sickening.

By KEVIN CLARKE, managing editor of online products at Claretian Publications in Chicago.