As a physician, I'm troubled by our nation's healthcare costs.

They have hit the $1.9 trillion mark and now consume 16 percent of the gross domestic product. That translates into a whopping $6,280 per person.

President Bush's plan to contain them with health savings accounts won't work. His proposal is a smokescreen to enrich insurance companies and banks at the expense of consumers who could lose traditional comprehensive coverage, assume more financial risk if they do get sick and foot more of their total healthcare expenses. Only high-income consumers will benefit from the tax breaks offered by these health savings accounts, and they will not help the uninsured.

The increasing number of for-profit, investor-owned hospital chains, specialty hospitals, HMOs and dialysis centers have also driven up healthcare costs by being significantly more expensive yet often providing inferior care to that offered by nonprofit centers.

Despite paying more than twice as much as most countries with universal healthcare, we leave 46 million Americans uninsured and millions more with inadequate health insurance.

In terms of health indicators like life expectancy, infant and maternal mortality, and obesity, we rank close to the bottom of the list of Western countries, according to the Organization for Economic Cooperation and Development.

Spiraling costs for poor-quality care cannot be sustained.

We cannot have an efficient and cost-conscious healthcare system based on private for-profit health insurance companies whose purpose is to maximize their profits by limiting their payments for actual healthcare.

The free-market model does not work in providing healthcare: Our current system wastes more than $300 billion a year. Administrative costs (including CEO salaries, profits, marketing, bureaucracy and paperwork) for private insurers are 14 percent or higher — compared to less than 3 percent for the original Medicare program, which has a single, government insurer while offering patients free choice of hospitals and doctors.

Given the turnover rate, private insurers have no stake in the long-term health of their patients, and therefore don't adequately invest in preventive care.

They also duplicate expensive technology and facilities, leading to excess capacity and higher total costs for healthcare.

Meanwhile, health insurance premiums have risen, and employers have transferred more of the costs to employees. By 2004, households were paying about 30 percent of their employer-sponsored insurance premiums. This is in addition to their out-of-pocket spending for copayments, deductibles and noncovered healthcare.

Yet despite this enormous financial burden on individuals, many have inadequate coverage when they get sick.

Half of the people filing for bankruptcy in the United States cited medical costs as the reason, according to a recent study published in the journal Health Affairs. And about 75 percent of those had health insurance when they became ill.

No wonder the majority of Americans are in favor of national healthcare. Unfortunately, neither the Republicans nor the Democrats are willing to back national health insurance, so it is essential for citizens to generate pressure on our politicians to step forward.

Our healthcare system is in crisis and will not be helped by further privatization. Healthcare is a precious human right that cannot be trusted to the vagaries of the profit-driven market model.

We need an improved "Medicare for All," single-payer healthcare system that will provide comprehensive healthcare to all Americans — and we need it now.