According to the Bush administration, the new health care plan that the President unveiled in the State of the Union address Tuesday would cover three million people who are currently uninsured. Three million – out of forty-seven million. After years of dangerous inaction, this is what Bush rolls out to address a grave and growing crisis!

And, of course, no Bush domestic proposal would be complete without a further gutting of the social compact – this time, “cutting Medicaid payments to public hospitals and other ‘safety net’ providers by $3.9 billion over the next five years.” As Deborah Bachrach, a deputy commissioner in the New York State Health Department, told the New York Times, this cut would impact hospitals “that serve some of the lowest-income, most vulnerable patients.” This at a time when many such facilities are already struggling to survive.

The Bush tax cuts for the wealthy survive untouched – in fact, they receive a new deduction if they purchase their own plans. However, the continuing War on the Middle Class is being…well, escalated. Workers who, according to the President, “choose overly expensive, gold-plated plans” through their employers will be taxed, while those who buy plans on their own will receive a deduction. As Columnist Paul Krugman suggested in a Times op-ed, who in our nation has one of those gold-plated plans? Krugman goes on to write, “The uninsured don’t need an ‘incentive’ to buy insurance; they need something that makes getting insurance possible…. Mr. Bush…is still peddling the fantasy that the free market, with a little help from tax cuts, solves all problems.”

“The President’s so-called health care proposal won’t help the uninsured, most of whom have limited incomes and are already in low tax brackets,” said Democratic Representative Pete Stark, Chairman of the Ways and Means Health Subcommittee. “But it will hurt middle-income Americans, whose employers will shift even more cost and risk to their employees.”

And as Gerald Shea, assistant to the president of the A.F.L.-C.I.O, told The Times, “It would throw into turmoil the employment-based system of health insurance, and it would impose a new tax on the middle class.”

Most experimentation (both good, not-so-good, and bad) with health care policy is happening at the state level. The often-touted Massachusetts plan – in the words of Doctors Steffi Woolhandler and David Himmelstein of Cambridge Hospital and Harvard Medical School – “offers empty promises and ignores real – and popular – solutions.” By requiring every resident of the state to have health insurance or pay a fine while doing nothing to control costs of insurance and care, or setting standards for coverage – Big Insurance wins, and consumers lose. And the middle-class which doesn’t qualify for subsidies but can’t afford insurance is further squeezed.

In California, Governor Arnold Schwarzenegger has proposed a similar plan. Again, the plan mandates coverage but, according to State Senator Sheila James Kuehl, “it doesn’t ensure that coverage will be comprehensive and affordable…. [it will] at best provide high-cost, low benefits plans for many Californians; it limits what employers pay but not what individuals must pay or what insurance companies can charge.”

Although Schwarzenegger has won praise for a “bipartisan approach,” in fact both his plan and that of Massachusetts Governor Milt Romney move in a direction Romney’s staff calls “a culture of insurance” and “personal responsibility.

State Sen. Kuehl herself has a plan for universal coverage that I previously reported on here. Her proposal – SB 840 – would offer all Californians comprehensive care and the right for a patient to choose his or her doctor. It would replace insurance companies with a statewide trust fund that collects premiums paid by employers and individuals. The creation of a single fund reduces administration costs from nearly 30 percent of total health care costs to under 10 percent. With 80 percent of Californians wanting a government guarantee of affordable health care coverage, one hopes state legislators will take another look at the Kuehl plan.

The Washington Post reports that Pennsylvania Governor Edward Rendell has proposed a tax – on tobacco and businesses not offering health care coverage – in order to create state-subsidized private insurance for its 767,000 uninsured people. Vermont, Illinois, and Maine have all enacted legislation to expand coverage of uninsured residents as well, and at least eleven other states are “considering” doing the same.

Meanwhile, at the federal level, any real action to improve this unacceptable situation – worse than any other industrialized nation in the world – will have to overcome a lot of naysayers (not to mention powerful lobbying interests with their campaign dollars). Consider these statements from three representatives to The Washington Post:

“The truth of the matter is that dealing with this problem between now and the election is not realistic,” said Senator George Voinovich.

“Congress is not going to act in a major way to deal with this access problem in the next couple of years,” said Senator Jeff Bingaman. “That’s the unfortunate reality that we’re facing.”

“If we tried to adopt a universal health-care plan on the federal level, we probably wouldn’t have the votes,” said Representative Frank Pallone Jr.

Nothing like negative, self-fulfilling prophecies to justify do-nothing proposals from our elected leaders.

The fact is there are 78 co-sponsors of HR 676 – the United States National Health Insurance Act introduced by Representatives John Conyers and Dennis Kucinich. There are 225 labor organizations supporting it as well. It would expand Medicare to every resident through savings from negotiated bulk procurement of medications; a tax on the top 5 percent of income earners; and a phased-in payroll tax that is lower than what employers currently pay for less comprehensive employee health coverage.

“There are only two real choices in the present healthcare debate… commercially-based models which reinforce the insurance industry and fail to provide genuine universal and comprehensive care, and HR 676, a patient-based model which caregivers know is the most effective, humane approach,” said Deborah Burger, president of the California Nurses Association/National Nurses Organizing Committee.

“Solutions to the health care crisis based on increasing our reliance on private health insurance companies are bound to fail,” said Dr. Oliver Fein, director of Physicians for a National Health Program. “Insurance companies limit patients’ choice of doctor and hospital, and take money out of patient care and put it into marketing, bill collectors and claims deniers. We need a National Health Insurance program.”

At a time when our nation is spending $8.4 billion per month in Iraq it is clear that the resources are available where there is political will. Just as the President proposes that we continue to follow his course of folly in Iraq, so too will he ask us to stay a course which causes the number of uninsured to grow year after year, and makes access to comprehensive health care a privilege for the fortunate who can afford it.

Tonight, when President Bush offers his flawed prescription for improving the state of health care, respond by signing on to the only real solution: universal health care now.