THE GOVERNMENT recently announced that 2.4 million people lost their health care coverage last year. Why was there such a dramatic increase?

IT'S PRETTY clear why there was a decline. There was a decline in jobs. And in this country, unfortunately, much of health insurance is tied to employment. When--as is happening with tragic frequency right now--people lose their jobs, they lose their insurance coverage. And it's not only them--it's their families, spouses and children.

There are some really tragic examples. The U.S. steel industry, which was once the largest in the world, is rapidly imploding. There have been 18 bankruptcies. The most recent is the LTV Steel colossus. What happens is that the work force not only loses their jobs, but they lose their pensions.

And most tragic of all, the employees who are discharged--and frequently, the retired workers who have enjoyed pension rights and retirement insurance benefits--find themselves abruptly without health coverage. These people may be 50 or 55 years old--with many years to go before Medicare kicks in.

These industries by definition are concentrated. For example, LTV was in western Pennsylvania and eastern Ohio, and a huge fraction of all the people living there were employed in that industry or were members of employees' families. You have a local catastrophe.

Leo Girard, the president of the steelworkers' union, very bitterly protested this development. I was there at his side when he said that only single payer national health insurance can remedy this. He knows this particularly because, it turns out, Mr. Girard is a Canadian--and knows what it's like to have a country that guarantees every person in it decent health care through a government system.

Those are the answers to the question "Why?" The more ominous reality is that this is almost certainly going to get worse. Employers are complaining bitterly--big employers, people like the heads of General Motors--that they can't absorb the double-digit increase that for-profit HMOs and for-profit hospital chains are demanding for next year's benefits.

And the corporations' response, of course, is to offload the new expenses--and some of the old, if possible--to the workers themselves, which is nothing more or less than an old-fashioned wage cut. So you have, literally, the health system lowering the standard of living for American workers.

IT SEEMS that most recent declines in coverage are concentrated among people who are "middle income."

YES, GOOD old "middle-class America." One can talk endlessly about the horrible impact on millions of individuals. The facts are that we alone in this country have a health system that is based on workplace benefits and individual purchases. Only for seniors and disabled people do we have a government single-payer system--which is a blessing, but it does mean that the vast majority of people stand in jeopardy of being without any insurance.

And when illness strikes, it's a total catastrophe. Beyond medically, it's an economic catastrophe. It's still true that the number one cause of personal bankruptcy is unpaid medical bills. That is appalling.

Since its inception in 1988, Physicians for a National Health Program has strongly urged single-payer national health insurance--a government-financed system, like Medicare, but with a private system of delivery. That is to say, people would have their own personal physician and could make a change if they wanted to.

And the system would cover the very serious, special burden of pharmaceutical costs--something that's skyrocketed in the last decade or so, particularly hitting seniors who enjoy Medicare protection of their treatment and diagnosis, but when it comes to the purchase of drugs, they're without any support.

IN AUGUST, Physicians for a National Health Program wrote about its proposal for a national health care plan in the prestigious Journal of the American Medical Association.

THE ARTICLE was formally endorsed by some 7,782 doctors. They signed statements saying they publicly endorsed this. Since its publication, we've had many more signatories. We're well past 10,000, and we hope to continue to invite doctors to endorse this very comprehensive, very progressive plan for American health care.

This plan establishes a system that includes absolutely everybody. Our slogan is "everybody in, nobody out." So there's no classes, there's no means test, there's no age test, no race test, no gender test--you're in.

Immediately, when you have one insurer--the government or its designate--you save $200 billion in administrative costs. Much-needed dollars that are squandered now on useless bureaucracy would be available for paying for pharmaceuticals, for addressing long-term care needs in an aging population and covering many things like mental health, which are poorly covered in all of our systems.

ONE OF the things that your proposal pointed out is that people in the U.S. spend $1.6 trillion on health care, enough to cover every single person under a single-payer health care system.

IT'S TWICE as much per capita as the next countries to us. The next countries have universal health care, meaning everybody in, and they have far better indices of health--by that, I mean life expectancy, freedom from preventable disease, lower infant mortality rates. You name the index, and country after country does better than us--even though the country with the next and closest expenditure is half of what we spend.

We're up to $6,000 per person, even though 44 million people are uninsured, and 50 million more have very poor insurance. Even though that large number of people do not have formal coverage, we're averaging $6,000 per year per person. France, Germany and Switzerland all spend about $3,000, Canada about $2,200, and Britain about $2,000.

So I mention those figures to indicate that these countries, which resemble the U.S. in terms of their economic and political systems, are able to cover all their people for a fraction of what we spend--and get better outcomes. It's ridiculous that we're the one nation out of step.

THERE'S A common perception in the media that a national health care system would mean dramatically higher taxes and worse health care. What's your opinion?

THAT'S ALMOST a self-evident lie. Sixty percent of our current health system comes from taxes, directly or indirectly. And that 60 percent, ironically, exceeds what any other country pays out of their government tax system for their entire health system.

We have, in addition to that initial 60 percent, the next 40 percent, which is paid for in two ways. One is out-of-pocket, and Americans have the "privilege" of having more out-of-pocket costs than any other country. And, finally, in lieu of wages, when they get health insurance benefits at the workplace--which is very seriously in jeopardy.

So, every aspect of our finances is under pressure. It doesn't help that the economy facing challenges, or that we are squandering our federal dollars on tax cuts and military adventures. So we have a "perfect storm" as far as the health care system is concerned.

And people are seriously hurt. To be unable to get care when you have something serious--a heart attack, a broken limb, a sick child--demoralizes people.

We believe that half of any political situation that's necessary to achieve social change is well developed. I refer to the half that speaks to discontent and disarray. The other half--an organized effort to change the system, like the civil rights movement--lies ahead.

The most important missing player is labor. In every country in the world that has the system that we're talking about, it was always labor that led the fight--labor parties or labor unions. In this country, not only is the trade union movement very weak, but it's also caught up in this employer-based system, where workers get their benefits through work.

That worked for a long time. It must be said that a lot of labor unions pointed to the health insurance packages that they gained through strikes or through negotiations with pride. But now, these things are beginning to melt. We hope labor, sooner or later, will come to its senses and demand the only answer: single-payer national health insurance.

ONE OF the striking things about the new government statistics is that Medicaid and the state Children's Health Insurance Program added 4 million people to their programs last year, and yet at the same time, budget deficits in most states and at the federal level mean that those programs will see their budgets slashed.

ABSOLUTELY. THE states are in deficit spending, and they look at the budget and the "Mount Everest" is the amount that goes to Medicaid--a system that has many weaknesses. There was some movement towards enhancing Medicaid coverage to certain low-income kids and their families. But that is all going to be reexamined and withdrawn.

It's one of the more cynical formulas that I hear politicians talk about, who say "Let's shift this to the states." The states are in the position of offloading what they're already doing, which is only a partial job. So it's amateur night in the lunatic asylum when it comes to health care benefits and health care planning.

I'm hoping that the public will be able to overcome all of the powerful disinformation and political control that the power brokers in health care have. This is a $1.7 trillion industry.

The players--meaning the for-profit hospitals, the for-profit HMOs and the huge drug companies--have got stakes in this that are almost unimaginably high. And they've demonstrated that they're ready to do whatever it takes to preserve their privileges. There are now, for example, more highly paid lobbyists for the drug companies alone--not to mention the other groups--than there are members of Congress.

When you talk about highly paid lobbyists, it doesn't mean one guy with a fancy suit and a few dollars in his pocket--it means a staff, and it means financial contributions. They give tens of billions to these congresspeople--who seem quite willing to take it and let them write the laws.

That means we have a tough fight. It's a classic fight, but it's a good fight.

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