Rx for the system: we know how to create a better system. All we need is the moral outrage.

CLAUDIA KALMER and her husband, Doug, have always been proudly self-reliant. They have built their lives and livelihood around a small farm and nursery and selling their stained glass art at craft fairs. A road accident this fall leaves them wondering whether any of that will be left a few months from now. Claudia was slightly injured; Doug nearly died. He is recovering, but the flood of medical bills threatens to engulf them.

"It's terrifying," says Claudia, voicing the fears of millions of American who lack adequate health coverage.

The Kalmers are typical of uninsured Americans. Like them, two-thirds of the uninsured live in working households. They lack coverage not by choice, but because the steady rise in medical costs over a half century has priced coverage beyond their means. In addition to the 46.6 million Americans who have no coverage at all, at least as many people have insurance that is so limited or riddled with exclusions that it is nearly worthless. Working families who still have decent coverage worry it won't last.

The Institute of Medicine estimates that, each year, 18,000 uninsured Americans die prematurely because they cannot access adequate, timely medical care. Emergency rooms treat trauma victims like the Kalmers, but people with life-threatening chronic illnesses simply go without care. Uninsured medical debt is now the leading cause of personal bankruptcy in the U.S.

As every other industrialized nation has shown, it doesn't have to be that way. The plight of the Kalmers and millions of other families is not a natural phenomenon but the result of dysfunctional public policies that are as morally bankrupt as they are financially rumous.

In terms of clinical expertise in treating certain illnesses, the U.S. has the best health care in the world. In overall World Health Organization measures such as infant mortality and life expectancy, however, the U.S. falls behind a score of other nations.

It is not for lack of money. Few people realize that American taxpayers spend more in public subsidies for their health care system than taxpayers in any other country except Germany. Unlike other countries, America's health care system also demands huge outlaws from patients and employers. This combination of massive public and private contributions produces total spending on health care that already far exceeds what universal coverage would cost.

Any number of policy alternatives would enable us to join the other industrialized nations in providing coverage to all of our citizens. It makes sense to build on established public programs that enjoy strong middle-class support, such as Medicare, the Veterans Administration system, and the government insurance plan for federal employees and members of Congress. We could allow businesses and individuals to buy coverage in one or more of these programs, with the government subsidizing coverage for those unable to pay.

Alternatively, we could require more businesses to provide coverage for their employees, while broadening Medicaid and the State Children's Health Insurance Program, which now cover only a fraction of low-income families. That would be less efficient but would encounter less political resistance from the health care and insurance industries.

So, if we have the money and the know-how to address the problem, why don't we? How can we tolerate the massive human suffering that results from rationing care in the most richly endowed health care system in the world? In part, it is because the pharmaceutical companies, insurance industry, hospital chains, and HMOs that profit from the inefficiencies and inequities of the present system quite understandably resist reform. The rest of the answer--the part we have the power to change--is that Americans have not made better stewardship of our abundant health resources a political priority. Both political parties refer vaguely to health reform, but neither offers specific policies. Politicians remember the Clintons' failed attempt to enact health reform and the Democrats' subsequent loss of Congress. On this issue, only when the people lead will the leaders follow.

Faith communities must provide that leadership, helping Americans see that a more just health care system is both necessary and achievable.

Gordon Bonnyman is executive director of the Tennessee Justice Center, which advocates for low-income Tennesseans.