The most important issue.

Byline: The Register-Guard

Why isn't it a national disgrace to learn that the number of Americans without health insurance has climbed to 47 million? How do the citizens of the wealthiest nation in the world go to sleep each night knowing that almost 9 million of their children will wake up the next morning without medical coverage?

What kind of president, confronted with these appalling statistics, would defiantly threaten to veto a bill designed to provide health insurance for more children, and then tell people to quit whining because if they really need to see a doctor, "They can go to the emergency room"?

The idea that the private insurance industry is somehow going to solve this problem while preserving its handsome profit margins is classic magical thinking. The ranks of the have risen every year for the past six years largely because the health insurance provided by private companies is becoming unaffordable for individuals, families and employers.

The U.S. Census Bureau report released Tuesday underscores that this isn't just a problem for poor people, although low-income families suffer the most from lack of access to adequate health care. The fabric that holds the health care safety net together is fraying, and the holes are now wide enough to allow many with middle-class incomes to slip through.

Almost 60 percent of the uninsured worked full or part time during 2006. Eighteen percent of the uninsured lived in households with annual incomes between $50,000 and $74,999, and 8.5 percent had annual household incomes greater than $75,000.

The biggest reason for the increase in the number of people without health insurance, according to Census Bureau officials, is the reduction or elimination of employer-provided coverage. The percentage of people covered through employers declined from 60.2 percent in 2005 to 59.7 percent in 2006. As the cost of providing coverage continues to climb, employers pass more of the increase on to their employees, many of whom respond by canceling their health insurance.

Incomes simply aren't keeping up with the cost of coverage. A survey released last year by the Kaiser Family Foundation/Health Research and Educational Trust found that worker premiums in 2006 increased by 7.7 percent, while wages increased by only 3.8 percent.

President Bush's declaration that the emergency rooms of America stand ready to treat the millions without health insurance is, in a word, clueless. The nation's emergency rooms already are overwhelmed, and it is old news that the staggering costs of turning ERs into clinics of last resort for the uninsured forces hospitals to shift those costs to paying patients. The president ought to know that cost shifting is one of the big reasons insurance premiums are out of control.

There is a more fundamental reason to put an end to the disgrace of allowing 47 million Americans to go without health insurance: It perpetuates racial and economic discrimination in an area that should be considered a basic human right.

Uninsured rates for whites remained constant in the latest Census report at 10.8 percent, but rose among blacks - from 19 percent in 2005 to 20.5 percent in 2006. The percentage and the number of uninsured Hispanics increased to 34.1 percent and 15.3 million.

Ignoring the uninsured also condones the fact that they do not receive the same care as people who have health insurance. Research published in the latest issue of the Journal of the American Medical Association found that uninsured individuals who experienced an injury or illness received less medical care and had poorer health outcomes than people with insurance.

The problem of the uninsured is a legitimate crisis and a national disgrace. It will not be solved with silly tax breaks and should not be left to a patchwork of well-meaning but inadequate state programs.

Voters must hold presidential candidates accountable by demanding that they present specific strategies for providing universal coverage for Americans. It is the most important domestic issue in the campaign.